Community Health Needs Assessment

Transcription

ST. JOSEPH HOSPITAL, ST. MARY
COMMUNITY HEALTH NEEDS ASSESSMENT REPORT
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St. Joseph Health, St. Mary
Community Health Needs Assessment Report*
* Updated to align with The Patient Protection and Affordable Care Act (Pub. L. 111-148) added section 501(r) to
the Internal Revenue Code, which imposes new requirements on non-profit hospitals. Section 501(r)(3) requires
a hospital organization to conduct a community health needs assessment (CHNA) every three years and adopt
an implementation strategy to meet the community health needs identified through such assessment. The
CHNA must (1) take into account input from persons who represent the broad interests of the community
served by the hospital facility, including those with special knowledge of or expertise in public health and (2) be
made widely available to the public. Section 501(r)(3)(B). St. Joseph Health, St. Mary relied on Notice 2011-52:
Notice and Request for Comments Regarding the Community Health Needs Assessment Requirements for TaxExempt Hospitals to meet the requirements.
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Table of Contents
MISSION, VISION AND VALUES
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3
INTRODUCTION
Who We Are and Why We Exist
3
ORGANIZATIONAL COMMITMENT
Community Benefit Governance and Management Structure
4
OUR COMMUNITY
Defining the Community Benefit Service Area
6
METHODOLOGY
Analytic Methods Used
Prioritization Process and Criteria
Information Gaps
Collaborative Agencies
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10
10
PRIMARY AND SECONDARY DATA
Community Input
11
SOCIO-DEMOGRAPHICS, HEALTH OUTCOMES AND HEALTH STATUS
Greater High Desert Region: Inland Empire North Region of San Bernardino County
General Health Status
Death, Disease and Chronic Conditions
Infectious Disease, Births
Modifiable Health Risks
Access to Health Services
Health Education and Outreach
Perceptions of Health Care
12
COMMUNITY NEEDS
14
ATTACHMENTS
Appendix 1. Community Input
Appendix 2: Consultant and Other Public Health Experts
Appendix 3a: Facilities that provide health care services in High Desert Region, San Bernardino County
Appendix 3b: Other Facilities that provide healthcare in Southern California, affiliated with St. Joseph Health
Appendix 4: Community Benefit Committee Roster
Appendix 5: 2011 PRC Community Health Report: Community Health Findings, Greater High Desert Region,
Inland Empire North Region of San Bernardino County
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MISSION, VISION AND VALUES
Our Mission
To extend the healing ministry of Jesus in the tradition of the Sisters of St. Joseph of Orange by continually
improving the health and quality of life of people in the communities we serve.
Our Vision
We bring people together to provide compassionate care, promote health improvement and create healthy
communities.
Our Values
The four core values of St. Joseph Health -- Service, Excellence, Dignity and Justice -- are the guiding principles for
all we do, shaping our interactions with those whom we are privileged to serve.
INTRODUCTION WHO WE ARE AND WHY WE EXIST
St. Joseph Health, St. Mary is a comprehensive 210-bed nonprofit medical center serving the high desert region
of San Bernardino County for over five decades. The hospital employs over 1,700 as one of the region s largest
employers. The hospital offers a wide range of services from wellness and prevention programs to emergency
department and heart care services including the region s only open heart surgery program. St. Joseph Health,
St. Mary services include: 24-hour Emergency Services, Comprehensive Cardiac Services, an Outpatient Surgery
Pavilion, Mobile Health Services, Diabetes Education, Level II Neonatal Intensive Care, Robotic-Assisted Surgery
Program and a Center for Wound Care & Hyperbaric Medicine, a STEMI receiving center and with Baby Friendly
designation. A notable achievement, St. Mary s Community Health department s midwifery program surpassed
Healthy People 2020 goals for low birth rate and pre-natal care. Additionally, the hospital is recognized by San
Bernardino County public health as a key partner for improving health outcomes. Furthering its mission and its
commitment to providing access to quality healthcare, St. Joseph, St. Mary is building a new 128 bed hospital
that will open in 2016. The new facility will help alleviate a shortage of local hospital bed availability and bring
trauma services to the community.
The primary and secondary service areas of St. Mary consist of 400,000 residents living in the communities of
Adelanto, Apple Valley, Barstow, Hesperia, Lucerne Valley, Phelan, Oak Hills, Victorville and Wrightwood. 2010
US Census reports a 19.1% increase in population between 2000 and 2010. Hispanic residents now comprise
49.2% of the total population with the African American population estimated at 8.9%. Data from the hospital s
interpreter services program indicates Spanish followed by Arabic as the two most commonly requested non
English languages for discussing healthcare. The region is impacted significantly in the economic downturn with
one of the state s highest home foreclosure rates and a 50% increase in Food Stamp enrollment. The County s
unemployment rate was 12.6% (vs. 10.7% for the state) as reported for June 2012 by the state s Employment
Development Department.
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ORGANIZATIONAL COMMITMENT
Community Benefit Governance and Management Structure
The St. Joseph Health, St. Mary Community Benefit (CB) Committee is a formal committee of the hospital s
Board of Trustees (BOT) which oversees the direction of programs serving community needs. The CB Committee
meets quarterly to review and discuss progress implementing community benefit programs as well as programs
exclusively serving the needs of the poor. A board member chairs the CB Committee with additional board
members appointed terms. Hospital representatives include the President and Chief Executive Officer and the
Vice President for Mission Integration as well as the Director of Community Health and Healthy Communities.
Committee membership also includes community leaders with knowledge of health and social needs including
care for those without a home or food. Committee activities include review of partner and hospital programs
addressing social and health needs. The CB Committee reports to the hospital s BOT its recommendations on
programs assisting the poor, making grant awards to community partners and which community benefit
programs will be pursued. As a product of completing the 2011 Community Health Needs Assessment, the
hospital s CB committee includes a representative from San Bernardino County Public Health and Inland Empire
Health Plan (IEHP). The public health representative oversees development of community clinics including
efforts to expand Federally Qualified Health Centers throughout San Bernardino County and, in particular, to the
Victor Valley where currently none exist. The IEHP representative has expertise with the health and social needs
of low income persons using Medi-Cal health insurance. IEHP provides the committee insight on the barriers
low income patients experience accessing both primary and specialty care. A third committee member,
representing the Women, Infant and Children s program (WIC) is expert in breastfeeding which aligns with the
hospital s efforts to improve performance with its Baby Friendly designation.
In FY 11 CB Committee members reviewed and approved results of a Community Health Needs Assessment,
approval of St. Mary s FY 12- FY 14 Community Benefit Plan and recruitment of new committee members with
expertise in the new plan s initiatives. The new plan includes initiatives designed to address the following
community needs: (1) access to care, (2) childhood obesity, (3) diabetes and (4) breastfeeding. With the access
to care initiative, the Committee approved recruiting health partners to open four (4) community clinics serving
low income persons. This strategy was discussed in the context of partnering with like-minded health
organizations to serve the community s poor. The decision to expand clinics was determined from community
feedback and community health needs assessment data indicating the community faces barriers to accessing
care (across six (6) issues: (1) Getting a Dr. Appointment, (2) Cost of Prescriptions, (3) Cost of Dr. Visit, (4)
Inconvenient Office Hours, (5) Finding a Dr. and (6) Lack of Transportation) at a rate significantly higher than the
national average. Community residents of Adelanto, the poorest community in the region, have been
advocating for years that additional health resources (beyond the clinic operated by the hospital specializing in
maternal care) be provided to its 32,000 residents. Currently the community has few physicians and dentists
and no Urgent Care to treat emergencies. The hospital had identified local clinic partners and believed its
advocacy and local knowledge would assist new community health clinics to open, including a location in
Adelanto. The committee s decision addressing child obesity stems from recognizing that excess weight is the
underlying contributor to many chronic diseases and local health data indicates obesity rates higher than the
state level. Additionally, the hospital s parent organization, St. Joseph Health developed an effective childhood
obesity program (named Healthy For Life) with school partners in Orange County, CA. The committee approved
implementing this child obesity program at Head Start schools serving low income families. Likewise the
prevalence of Diabetes was identified higher than state and national levels and the committee approved
developing a diabetes self-management program (targeting uninsured persons) to meet Healthy People 2020
goals. Finally, the committee agreed that building upon the hospital s expertise with Baby Friendly would
further benefit women and children particularly if a program could increase the percentage of mothers
providing breast milk to their children at six months post discharge.
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The committee identified these programs based on how these issues were:
(1) impacting the community;
(2) the extent to which hospital resources could assist with the issue, and
(3) the quality of partnerships and programs to make a measurable difference.
Feedback from the community identified expanding access to services as the highest community need with job
creation a close second. This feedback was obtained from conducting meetings with residents and community
leaders as well as feedback from health experts with San Bernardino County Public Health, Inland Empire Health
Plan, and not-for-profit hospitals including Kaiser Permanente, Dignity Health, Loma Linda Medical Center and
Victor Valley Community Hospital. These hospital partners are using community benefit resources to
collaborate with San Bernardino County Public to improve health planning. The collaborative has successfully
influenced that wellness and disease prevention be pursued in San Bernardino County s new vision statement
http://www.sbcounty.gov/Uploads/CAO/Vision/elements.pdf#wellness. The Community Benefit Collaborative
initially formed to share approaches in conducting community health needs assessments in an effort to see if a
collaborative health assessment was possible and to begin assisting San Bernardino County Public Health in the
development of its own county-wide community health needs assessment. The county has developed a San
Bernardino County Healthy Communities program tracking key health metrics at the county wide level and
listing local best practices for health improvement http://www.healthysanbernardinocounty.org/index.php. St.
Mary has been urging county public health to consider adopting a Community Health Needs Assessment
approach where the health status of residents can be reported at a zip code level. This approach is the one
taken by St. Mary through its work with Professional Research Consultants. Community Feedback has been
most positive to the measurement and reporting of health conditions at the community level. This is enabling
the hospital to more effectively discuss health as a community issue. Residents are more engaged about what
actions its community should take its address the prevalence of a given disease. The hospital believes this
approach is feasible and is a step to addressing population health and the targeting of limited resources and best
practice interventions.
Our Community
St. Joseph Health, St. Mary is a comprehensive 210-bed nonprofit medical center serving the high desert region
of San Bernardino County. San Bernardino County is the largest county by area in the United States at 20,052.50
square miles located in the southeastern portion of CA. The thinly populated deserts and mountains of this vast
county stretch from the outskirts of Riverside-San Bernardino Area to the Nevada border and the Colorado
River. San Bernardino County is considered part of what is commonly referred to as the Inland Empire region of
southern California (along with Riverside County) and had a population of 1,422,745 according to the 2010
Census. San Bernardino County is comprised of three distinct population centers. First, is the Valley Region
which is the most populous and contains 75% of the county s residents yet accounts for only 2.5% of the land.
Then there is the Mountain Region which is primarily public lands owned by federal and state agencies. Third, is
the High Desert region encompassing 93% of the county s land area, including parts of the Mojave Desert.
Residents only occupy 101.5 per sq. mi. of the county; nearly 75% of land is open or undeveloped, 14.3% is used
for military purposes and 8.9% is used for residential housing. The community has experienced rapid population
growth as affordable housing attracted residents from neighboring Los Angeles and Orange counties. The
marked increase in population has been stressing the rural environment to expand and serve the challenges
brought about through urbanization. As a result, new schools and roads have been constructed and additional
health needs will be met including construction of new hospitals and recruitment of physicians and clinics.
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Community Served
The hospital s Community Benefit Service Area is roughly defined as serving the Victor Valley region of San
Bernardino County an area (as depicted below) with a 2010 population of 350,000 residents. The communities
Map
of Apple Valley, Hesperia and Victorville comprise the hospital s primary service area and the remaining
surrounding communities of Adelanto, Oro Grande, Phelan, Oak Hills and Lucerne Valley comprise the hospital s
secondary service area. The region is 90% desert and the largest nearest metropolitan area - the City of San
Bernardino is 40 miles away. The service area is noted as having significantly higher percentages of both
indigent and uninsured populations when compared with both state and national levels. Additionally, residents
suffer from heart disease and stroke at levels well above California and national benchmarks. As a result over
90% of the hospital s community benefit area has been identified as High Need from the SJHS mapping and
scoring of socioeconomic indicators contributing to health disparities. Over the past several years the hospital s
community benefit expenditures have increased to over $15 million. As noted the hospital s service area is
comprised of four major communities with some unique demographic, economic and health characteristics. The
largest city is Victorville with a population of 130,145 residents. Demographic data indicates that 43.14% of
residents are Latino and 28% of families prefer to speak Spanish, their primary language, at home.
Socioeconomic data reports 16% of families are living in poverty and health assessment data indicates 24% of
residents experience Fair or Poor physical health, the highest percentage among the four cities. The city of
Hesperia has 98, 442 residents with 15.4% of families living below poverty and 22% of residents over age 25 with
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no High School diploma. The hospital s home community of Apple Valley has 78,303 residents. Residents aged
65 years and older make up 14% of the population the highest concentration in the hospital s service area and
14.6% of families are living below poverty the lowest percentage of any city. The area s fourth city is Adelanto
with a population of 32,602 residents. Adelanto is noted for being the region s most ethnically diverse as 63% of
residents are Latino and another 10% African American. Socioeconomic data reports 26% of Adelanto families
are living in poverty and 28% of households have no high school diploma the highest rankings in the region.
METHODOLOGY
ANALYTIC METHODS USED
St. Joseph Health, St. Mary Medical Center conducted its Community Health Needs Assessment (CHNA) in the
cities of Apple Valley, Hesperia and Victorville - which comprise the hospital s Primary Service Area (PSA) as well
as the city of Adelanto along with numerous smaller communities comprising the hospital s Secondary Service
Area (SSA) between February 2011 and November 2011. Professional Research Consultants (PRC) was
contracted to conduct a randomized telephone survey, to obtain primary data from households within the
hospital s PSA and SSA developing survey sample sizes representative of the PSA and SSA for both population
and demographic characteristics. The survey instrument is based largely on the Centers For Disease Control and
Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BFRSS) with the hospital adding questions on heart
disease and stroke.
Currently, San Bernardino County has the second highest heart disease rate in California. A sample size of 300
households was determined as representative for the hospital s PSA with an additional 100 households sampled
for the hospital s SSA. A total of 400 households were sampled by PRC. Additionally, for comparison, PRC
collected secondary health data from the following sources: California Department of Public Health, Center for
Social Services Research, and University of Berkeley, California, Department of Justice, Centers for Disease
Control and Prevention, ESRI Demographic Portfolio (based on US Census projections), FBI Crime in the United
States and the National Center for Health Statistics. PRC also provided health benchmarking data from the
following sources: California Risk Factor Data, Nationwide Risk Factor Data and Healthy People 2020. The
hospital also collected health insurance data from Inland Empire Health Plan to track populations of uninsured
at the city level.
SJH conducted mapping of St. Mary s PSA and SSA using 2010 US Census Data. SJH applied a Community Needs
Index and ranked PSA neighborhoods using five (5) socioeconomic indicators (Income, Culture, Education,
Insurance and Housing) and identified communities with highest barriers. SJHS also conducted mapping of PSA
and SSA neighborhoods using an Intercity Hardship Index to rank order communities with highest barriers
(disparities) to care. This mapping process enables the hospital to target health interventions and grant
assistance to these high need communities. The city of Adelanto ranks the highest in unmet needs as
measured by the Intercity Hardship Index as well as by the lack of community resources commonly seen in the
neighboring communities of Apple Valley, Hesperia and Victorville. The city s very affordable housing masks
restricted community assets for its 32,000 residents including high school or college classes, no hospital or
urgent care center and virtually no park and recreation department.
Telephone Survey
PRC conducted a telephone survey of 146 questions focused on issues such as general health, chronic disease,
injury and violence, health risks, preventive care, access to healthcare services and broad community issues
between February 2011 and June 2011. The telephone survey was conducted on a stratified random sampling of
the population with 300 households sampled in the PSA and 100 households in the SSA. The survey
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questionnaire was modeled after the Centers for Disease Control s (CDC) Behavioral Risk Factor Surveillance
System, which enables benchmarking local results to statewide and national data. Data collected was
weighted in an effort to improve the representativeness of the data. Survey results were compiled by PRC in
a report and a presentation were used to assist in community feedback sessions. See Appendix 4
Key Informant Panels
As part of the community health assessment, four (4) key informant panels were held (two sessions in Apple
Valley, one session in Adelanto and the final session in Victorville). These panels included meetings with key
informants in the community, including physicians, other health professionals, social services providers,
employers and other community leaders. Participants were chosen because of their ability to identify primary
concerns of the populations with whom they work, as well as of the community overall.
Key Informant candidates were contacted by telephone and email. Follow-up phone calls were then made to
ascertain whether or not they would be able to attend and to plan for handout materials and surveys.
DATE
TIME
GROUP
PARTICIPANTS
March 11, 2011
9:30am-11:00am
Adelanto Community in Action
(Spanish) (12)
May 26, 2011
1:30pm-3:00pm
Community Benefits Stakeholder Meeting
(15)
July 28, 2011
2:00pm-4:00pm
Health and City leaders of the Healthy High Desert Collaborative
(7)
October 17, 2011 12:00pm- 1:30pm
Victor Valley Community Services Council
(10)
April 20, 2012
Healthcare & Social Issues in the High Desert
(12)
9:50am-11:00am
Community/Resident Forums
A focus group meeting was conducted in Adelanto, in March, 11, 2011 to prioritize and understand residents
and stakeholders views of the most pressing health and quality of life issues. Community forums were
conducted with assistance of Ms. Carmen Laird, Mr. Martin Chavez and Ms. Maria Lara to engage Spanish
speaking residents to provide feedback to CHNA findings specific to the community. On July 28, 2011 a focus
group meeting was held with health and social service providers of Healthy High Desert. On October 17, 2011 a
focus group meeting was held with local social service providers at a Victor Valley Community Services Council
meeting.
A summary of the aggregate findings1 from the telephone survey community needs assessment conducted by
PRC were presented to participants. Participants were then allowed to identify new health and quality of life
issues that they felt were important in the particular city and were not part of the phone survey results. The
facilitator then aggregated the new issues with the phone survey results, referred to collectively as health
issues.
1
NOTE: These findings represent qualitative rather than quantitative data. The groups were designed to gather input from
participants regarding their opinions and perceptions of the health of the residents in the area. Thus, these findings are
based on perceptions, not facts. Please see Appendix 5.
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Participants collectively ratified the results via consensus. The facilitator then led a focus group using semistructured interview questions in order to obtain the participants reflections on the issue and to discuss what
the participants believed to be the root causes for the issues.
Identification of Community Organizations
Key Informant panels consisted of representatives from the following agencies. Names are not connected with
the comments, as participants were asked to speak candidly and assured of confidentiality.
St. Joseph Heritage Health
Town of Apple Valley Parks and Recreation
High Desert Primary Care Medical Group
Victor Valley Community Services Dental Program
San Bernardino County Public Health
Healthy Rancho Cucamonga
San Joaquin Valley Community College
City of Victorville
Mojave Water Agency
ICR Staffing
Victor Valley Elementary School District
Desert Community Bank
Adelanto Community ToolBox
Adelanto Elementary School District
Prioritization Process and Criteria
St. Joseph Health, St. Mary s Community Benefit Committee considered the following criteria: Relative
prevalence of health and quality of life issues in each community, including whether local residents
identify the topic as an issue and has a perceived sense of importance, scope of the issue when
compared to state or national data, seriousness and consequences if left unaddressed, availability of
community resources to assist in addressing the issue, overall alignment with hospital goals and
strategic priorities, and alignment in managing charity care costs. In addition, the hospital s Community
Benefit Committee used the following lens to select and prioritize initiatives: High impact on the poor
and vulnerable; Identified by resident forums and, or PRC data; At least one issue must address a
Quality of Life concern; Partners/momentum exists to work collaboratively; Existence of a reasonable
outcome; Availability of St. Joseph Health, St. Mary s capacity and resources to lead efforts; Alternative
resources are not available.
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Information Gaps
The agency used to identify needs, Professional Research Consultants, Inc. (PRC) currently utilize the
telephone to conduct surveys. We recognize this limits access to people who may not own traditional
home-based telephones and those residents who are homeless. Despite this, it did not affect St. Joseph
Health, St. Mary s ability to reach reasonable conclusions regarding community health needs. An
overarching need of the region is expansion of health services in almost all facets of care from increasing
hospital beds, to providing specialty care, to expanding primary care to establishing additional
community clinics to serve the poor. Hospital s collaborating with St. Mary (i.e., Loma Linda and Kaiser
Permanente) shared results of their CHNAs which also identified the need for expanded access as a key
need.
Collaborative Agencies
.
We have a broad network of agencies with whom we collaborate on a regular basis. Because of these
relationships, we were able to gain insight and feedback during the needs assessment process from the
following agencies:
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San Bernardino County Public Health Department
San Bernardino County Healthy Communities Department
Inland Empire Health Plan
Molina Health
Loma Linda Medical School
Kaiser Permanente
Dignity Health St. Bernadine s Hospital
High Desert Resource Network
Victor Valley Community Services Council
San Bernardino County Community Clinic Association
Hospital Association of Southern California
Healthy Adelanto, Healthy Apple Valley, Healthy Hesperia and Healthy Victorville
St. John of God Health Care Services
Catholic Charities of the Diocese of San Bernardino and Riverside Counties
Collaboration ranged from promoting resident focus groups, identifying key informants to participating
in panel discussions and working together to create strategic plans once the needs assessment was
completed.
Identity and Qualifications of Third Parties
The 2011 CHNA phone survey, key stakeholder panels and written report was conducted by Professional
Research Consultants, Inc. (PRC). PRC is a nationally-recognized marketing research firm dedicated
exclusively to exploring health-related issues for hospitals, health systems, foundations and community-
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based groups. PRC has extensive experience conducting Community Health Needs Assessments such as
this in hundreds of communities across the United States since 1994.
Bruce Lockwood, Director, Community Health Division
Professional Research Consultants, Inc.
As division director, Bruce Lockwood oversees all aspects of community health assessment research for
Professional Research Consultant, Inc. (PRC). Mr. Lockwood was instrumental in the development of
PRC s Community Health Assessment research product offering from its inception, including refining
PRC s approach, core survey instruments, data collection and reporting tools.
Mr. Lockwood has been with PRC since 1990, and has overseen Community Health Assessment projects
in more than 300 communities nationwide. Mr. Lockwood received a Bachelor of Arts degree summa
cum laude from the University of Nebraska.
PRIMARY AND SECONDARY DATA
SOCIO-DEMOGRAPHICS, HEALTH OUTCOMES AND HEALTH STATUS
Greater High Desert Region: Inland Empire North Region of San Bernardino County
This PRC Community Health Assessment is a systematic, data-driven approach to determining the health status,
behaviors and needs of residents in the primary and secondary service areas of St. Mary Medical Center.
Subsequently, this information may be used to inform decisions and guide efforts to improve community health
and wellness.
This assessment incorporates data from primary research (the 2011 PRC Community Health Survey) and
secondary research (vital statistics and other existing health related data). It also allows for comparison to
benchmark data at the state and national levels.
The PRC survey instrument used for this study is based largely on the Centers for Disease Control and Prevention
(CDC) Behavioral Risk Factor Surveillance System (BRFSS), as well as various other public health surveys and
customized questions addressing gaps in indicator data relative to health promotion and disease prevention
objectives and other recognized health issues. The final survey instrument was developed by St. Mary Medical
Center and Professional Research Consultants (PRC). The community defined for this assessment is made up of
St. Mary Medical Center's Primary Service Area (comprised of the Apple Valley, Hesperia, and Victorville
communities) and remaining surrounding communities (Secondary Service Area). Each of these is defined at the
ZIP Code level.
A PRC Community Health Assessment provides the information so that communities may identify issues of
greatest concern and decide to commit resources to those areas, thereby making the greatest possible impact
on community health status.
The core areas examined are as follows: 1) General Health Status, 2) Death, Disease and Chronic Conditions,
Infectious Disease, Births, Modifiable Health Risks, Access to Health Services, Health Education and Outreach
and Perceptions of Health Care. (See Appendix 5, pages 25 through 195 to see detailed tables).
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This Community Health Assessment will serve as a tool toward reaching three basic goals:
- To improve residents health status, increase their life spans, and elevate their overall quality of life. A
healthy community is not only one where its residents suffer little from physical and mental illness, but also one
where its residents enjoy a high quality of life.
- To reduce the health disparities among residents. By gathering demographic information along with health
status and behavior data, it will be possible to identify population segments that are most at-risk for various
diseases and injuries. Intervention plans aimed at targeting these individuals
may then be developed to combat some of the socio-economic factors which
have historically had a negative impact on residents' health.
- To increase accessibility to preventive services for all community residents. More accessible preventive
services will prove beneficial in accomplishing the first goal (improving health status, increasing life spans, and
elevating the quality of life), as well as lowering the costs associated with caring for late-stage diseases resulting
from a lack of preventive care.
Community/Resident Forums
A focus group meeting was conducted in Adelanto, in March, 11, 2011 to prioritize and understand residents
and stakeholders views of the most pressing health and quality of life issues. Community forums were
conducted with assistance of Ms. Carmen Laird, Mr. Martin Chavez and Ms. Maria Lara to engage Spanish
speaking residents to provide feedback to CHNA findings specific to the community. On July 28, 2011 a focus
group meeting was held with health and social service providers of Healthy High Desert. On October 17, 2011 a
focus group meeting was held with local social service providers at a Victor Valley Community Services Council
meeting.
A summary of the aggregate findings from the telephone survey community needs assessment conducted by
PRC were presented to participants. Participants were then allowed to identify new health and quality of life
issues that they felt were important in the particular city and were not part of the phone survey results. The
facilitator then aggregated the new issues with the phone survey results, referred to collectively as health
issues.
Participants collectively ratified the results via consensus. The facilitator then led a focus group using semistructured interview questions in order to obtain the participants reflections on the issue and to discuss what
the participants believed to be the root causes for the issues.
See Appendix 5, pg. 195-196
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See Appendix 5
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COMMUNITY NEEDS
Summary of Community Health Needs
The list of prioritized community health needs identified through secondary data analysis and community input
are as follows:
Access to Healthcare
Lack of Insurance/Insurance Instability
Difficulty Accessing Healthcare Services
(Adults & Children)
Barriers to Healthcare Access (Cost, Transportation, Hours, Etc.)
Emergency Room Utilization
Perceptions of Local Healthcare Services
Diabetes
Diabetes Deaths
Diabetes Prevalence
Nutrition & Overweight
Fruit & Vegetable Consumption
Overweight/Obesity
Heart Disease & Stroke
Heart Disease & Stroke Deaths
Hypertension
Respiratory Disease
Chronic Lower Respiratory Disease Deaths
Pneumonia/Influenza Deaths
Oral Health
Dental Visits (Adults)
Maternal & Infant Health
Prenatal Care
Low Birth-weight
Infant Mortality
Family Planning
Births to Teens
Injury & Violence
Motor Vehicle Crash Deaths
Firearm-Related Deaths
Homicides
Violent Crime, Including Domestic Violence
Dementias
Alzheimer's Disease Deaths
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Disability
Activity Limitations
Substance Abuse
Cirrhosis/Liver Disease Deaths
Cancer
Cancer Deaths (Lung, Prostate, Female Breast, Colorectal)
Education
Attendance at Health Promotion Events
Vision
Blindness/Trouble Seeing
Routine Vision Care
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Appendix 1: Community Input
Local Community Leaders Providing Input
Local leaders provided input to the Key Informant panels, Resident Focus Groups, and the development of the
strategic plans. Ms. Carmen Laird and Mr. Martin Chavez were instrumental in holding Adelanto meetings with
Spanish speaking residents to address start-up of a Healthy City initiative and the residents pressing needs for
low cost health services including a clinic or Urgent Care. Meetings in Adelanto engaged low income and
Spanish speaking residents, many of whom are undocumented. Ms. Dora Barilla, MPH, Ph.D. provided
assistance advocating the county begin seed funding Healthy City initiatives in the region. Additionally, Dora
assigned Masters of Public Health interns from Loma Linda University Medical Center, to perform local public
health projects. Ms. Jennifer Resch-Silvestri, and Ms. Martha Valencia, MPH of Kaiser Permanente provided
feedback on collaborating to expand community clinics since Kaiser was grant funding a new community clinic
collaborative in San Bernardino County and clinics of the collaborative would consider expansion to the High
Desert. Because Key Informant Panels and Resident Focus Groups were held in confidentiality to ensure candid
dialogue surrounding community needs, these names cannot be shared during this needs assessment.
Identification of Community Organization and Individuals
Key Informant panels consisted of representatives from the following agencies. Names are not connected with
the comments, as participants were asked to speak candidly and assured of confidentiality.
Town of Apple Valley Parks and Recreation
High Desert Primary Care Medical Group
Victor Valley Community Services Dental Program
Healthy Rancho Cucamonga
San Joaquin Valley Community College
City of Victorville
Mojave Water Agency
ICR Staffing
Victor Valley Elementary School District
Desert Community Bank
Adelanto Community ToolBox
Adelanto Elementary School District
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Appendix 2: Consultant/Public Health Experts
Identity and Qualifications of Third Parties
The 2011 CHNA phone survey, key stakeholder panels and written report was conducted by Professional
Research Consultants, Inc. (PRC). PRC is a nationally-recognized marketing research firm dedicated
exclusively to exploring health-related issues for hospitals, health systems, foundations and communitybased groups. PRC has extensive experience conducting Community Health Needs Assessments such as this
in hundreds of communities across the United States since 1994.
Bruce Lockwood, Director, Community Health Division
As division director, Bruce Lockwood oversees all aspects of community health assessment research for
Professional Research Consultant, Inc. (PRC). Mr. Lockwood was instrumental in the development of PRC s
Community Health Assessment research product offering from its inception, including refining PRC s
approach, core survey instruments, data collection and reporting tools.
Mr. Lockwood has been with PRC since 1990, and has overseen Community Health Assessment projects in
more than 300 communities nationwide. Mr. Lockwood received a Bachelor of Arts degree summa cum
laude from the University of Nebraska.
Individuals Providing Public Health Expertise
Public Health experts provided input to the Key Informant panels as well as in the development of the
strategic plans, however, because Key Informant panels were held in confidentiality to ensure open, honest
feedback could be obtained for the needs assessment, these names cannot be shared during this needs
assessment. Future needs assessments will disclose names and agencies of public health experts as
requested by State or Federal agencies. Feedback was obtained by public health leaders at San Bernardino
County s Public Health Clinic and Healthy Communities Program. Public Health recognizes the hospital and
its community clinics as vital resources assisting a population center government services are overwhelmed
attempting to serve. As a result Public Health leaders have been supporting efforts supporting start-ups of
private community health clinics and providing seed funding to start Healthy City campaigns.
Page 18
Other Individuals Providing Input
Other individuals who provided expertise during the needs assessment process are identified below.
Name
Title and Affiliation
Expertise
Kevin Mahany, MGA
Director, Healthy Communities and
Advocacy
Allen Christensen, CHES
Community Organizing and
resident and business feedback
meetings
Community Organizing and
resident meetings
Laurie Roberts, CNM
Senior Vice President, Community
Health
St. Joseph Health
Azhar Qureshi, MD, MBA, DrPH
Marie Prosper, MPH, MBA
Verónica F. Gutiérrez, MPH
Project Manager, Community Health
St. Joseph Health
Community Benefit Manager,
Community Health
St. Joseph Health
Maternal Health
Public Health, statistical analysis
Community health and research
Community Health and Health
Disparities
Kevin Mahany, MGA is currently Director of Advocacy and Healthy Communities for St. Joseph Health,
St. Mary. Kevin is a returned Peace Corps volunteer who assisted in developing clean drinking water
and rural health clinics in the Solomon Islands and Papua New Guinea. Prior to working at St. Joseph
Health, Kevin worked in the environmental, health and safety field with expertise in childhood lead
poisoning. He is a member of the Hospital Association of Southern California s Community Benefit
Collaborative. The collaborative is comprised of not-for-profit hospitals in San Bernardino coordinating
efforts conducting community health needs assessments and coordinated implementation of
community benefit initiatives in partnership with San Bernardino County Public Health Department. The
collaborative supports the County-wide health vision of preventing disease, and addressing the county s
shortage of physicians and allied health professionals. An element of the county s vision is starting
Healthy City initiatives. As of 2011 the county has 13 Healthy City campaigns with four (4) located in the
service area of St. Joseph Health, St. Mary. Kevin assisted with the start of each city campaign and a
regional network named Healthy High Desert. Healthy High Desert is a collaborative of 40 local
organizations promoting prevention and the reduction of chronic disease. Kevin is a member of the San
Bernardino County Community Clinic Association which is addressing how to expand primary and
specialty care services to low income and uninsured populations. Kevin is a Board Member of the Inland
Empire Children s Health Initiative, the Apple Valley Police Activities League, Adelanto Community
Resource Center, the Apple Valley Chamber of Commerce and Apple Valley Oversight Committee and St.
John of God Health Care Services in Victorville. Kevin is also a member of Loma Linda Medical Center s
Community Benefit Advisory Committee and the Health Committee of the Diocese of San Bernardino.
Allen Christensen, CHES is Community Benefit Analyst and Healthy Cities Manager for St. Joseph Health,
St. Mary. He is a planning member of Healthy High Desert. Allen is a board member of the Adelanto
Chamber of Commerce and co-leads Healthy City efforts in Adelanto, Apple Valley, Hesperia and
Page 19
Victorville. Each campaign addresses community level issues impacting resident health including lack of
access to recreation and fresh produce, crime, complete streets, undue concentrations of alcohol,
tobacco and fast food establishments and the development of joint use agreements to open school
playgrounds to public use. Allen has served on a state-wide joint use planning taskforce overseen by the
California Department of Public Health named Project Lean.
Azhar Qureshi, MD, MPH, MBA, DrPH is currently Senior Vice President for Community Health, St.
Joseph Health (SJH). SJH is a not-for-profit healthcare organization that owns and operates fifteen
hospitals in California and Texas. The System employs 22,000 employees and reported gross revenues
of $4 billion for fiscal year 2012. Dr. Qureshi is also the Lead Consultant for the California Hospital
Association (CHA) on all issues concerning measurement and public reporting of hospital quality
performance in CA. He is also a member of the Board of Directors for Latino Health Access (LHA). Latino
Health Access is a nonprofit organization founded in 1993 in Santa Ana, California. LHA reaches out to
residents in laundromats, garages, churches and their recently-opened new headquarters to combat
serious public health problems plaguing a community of uninsured and under-served families.
Dr. Qureshi is also a member of the Board of Directors for National Health Foundation (NHF). National
Health Foundation has been addressing healthcare issues of the underserved for more than 35 years.
Throughout its history, the organization's mission and direction have evolved in order to best serve the
community, healthcare providers and policy makers. In addition to his MBA and Medical Degree, Dr.
Qureshi has a Master in Public Health with an emphasis on Community Health and Health Education. He
also has a Doctorate in Public Health with a cognate in Bio-Statistics from the University of California,
Los Angeles (UCLA). He has published various articles and has been invited to present at many
prestigious seminars. He has received many academic awards, scholarships and grants, including a
fellowship awarded by the Centers for Disease Control (CDC). Last, but not least, Dr. Qureshi was a
faculty member at the Center for Continuing Professional Education, Harvard School of Public Health
where he co-taught a course titled Probabilistic Risk Analysis: Assessment, Management and
Communication.
Marie Prosper, MPH, MBA graduated from the University of Michigan with a Bachelor of Arts degree in
Sociology and attended Loma Linda University where she received two Master degrees; one in Public
Health and the other in Business Administration. Marie is currently pursuing a PhD in Public Health with
a concentration in Epidemiology. She has had the opportunity to be involved in a variety of research
projects including youth violence in South African schools, motor behavior and development in infants
with Down s syndrome, and barriers to the use of nutrition centers by senior residents in San Bernardino
County, CA. Her most recent study exploring the relationship between obesity and self-rated health was
published in the American Journal of Health Behavior. She is most passionate about issues related to
health disparities, poverty, minority health, and maternal and child health. Marie is currently a Project
Manager in the Community Health Department at St. Joseph Health where she is dedicated to improving
the health and quality of life of underserved populations through research and evaluating effective
programs. In her current role, she lends her expertise in conducting community needs assessments,
program design and evaluation, research methods and biostatistics.
Verónica F. Gutiérrez, MPH received her Bachelor of Arts Degree in Sociology and Anthropology with a
concentration in Latin American Studies and a certificate in Spanish Language and Literature from
Carleton College in Northfield, Minnesota. Ms. Gutiérrez received her Master of Public Health Degree
with a specialization in Socio-Cultural Aspects of Health from University of California, Los Angeles (UCLA)
Fielding School of Public Health. Verónica is currently the Manager of Community Benefit for St. Joseph
Page 20
Health (SJH), a Catholic health care non-profit in Orange, California, where she coordinates system-wide
community benefit efforts aimed at improving the health and quality of life of local residents. She has
managed projects that include the implementation of performance improvement efforts in community
health and a project dedicated to build increased focus and accountability in governance, management
and operations of community health efforts across SJHS ministries (hospitals). Currently she serves on
the Bethany in Transition Board and the Wellness Corridor Stakeholder group convened by Latino Health
Access, a non-profit organization in Santa Ana, CA. Prior to joining St. Joseph Health, Verónica
collaborated on research on access to care and preventive care utilization at the UCLA Center for Health
Policy Research. She has also conducted qualitative research on therapeutic communication. She has
served on the Executive Board of the Latino Caucus, in official relations with American Public Health
Association (APHA), The Gerontological Health Section, APHA, and is co-founder of UCLA Students of
Color for Public Health.
Page 21
Appendix 3a
Facilities that provide healthcare in High Desert, San Bernardino County
St. Mary Community Health Clinics- Adelanto, Apple Valley and Hesperia
St. Joseph Health, St. Mary sponsors three (3) community health clinics serving low income
communities. In 2011 these clinics provided care for 42,439 patient encounters across all programs.
The clinics specialize in providing maternal care to low income persons including midwifery, behavioral
health, primary care, cancer screenings and diabetes education and self-care to Medi-Cal and uninsured
populations. The Adelanto clinic is located in to serve residents living in the poorest neighborhood in
the High Desert. Additionally, the department operates a mobile medical van serving low income
neighborhoods in Apple Valley and Victorville.
The following are other facilities providing health care in High Desert region, San Bernardino
County region. This list is not exhaustive.
Organization
Address
Description of Services
San Bernardino County Public
Health Clinic (FQHC)
16452 Bear Valley, Road
Hesperia, CA 92345
Primary Care Services, enrollment
into Low Income Health Program,
referrals to specialty care at
Arrowhead County Hospital
Mission Community
Clinic Network
15201 11th Street
Victorville, CA 92395
Primary Care
Victor Valley Community Services
Dental Program
14357 7th Street
Dental Services
Molina Medical Clinic
11965 Cactus Road
Adelanto, CA 92301
Primary and Pediatric Care
La Salle Medical Clinic
16455 Main Street
Hesperia, CA 92345
Primary and Pediatric Care
High Desert Primary Care
12550 Hesperia Road
Primary and Specialty Care with
Urgent Care Clinics
Choice Medical Group
18564 Highway 18
Apple Valley, CA 92307
Primary and Specialty Care
Physician Group
Kaiser Permanente
14011 Park Ave.
Primary and Specialty Care
Victor Valley Community Hospital
15428 11th Street
101 Bed Acute Care Hospital
Desert Valley Hospital
16850 Bear Valley Road
148 Bed Acute Care Hospital
Page 22
Appendix 3b (continued)
Other Facilities that provide healthcare in Southern California, affiliated with St.
Joseph Health
The following are other facilities providing health care in Orange County region. This list is not
exhaustive.
Organization
Address
Description
St. Joseph Health, St. Joseph
Hospital Orange*
1100 West Stewart St.,
Orange, CA 92868
SJH, SJO provides a comprehensive
range of services, centers and programs:
Anesthesia Services, Bariatric Care
Center, In-patient Behavioral
Health/Psychological Services, Blood
Donor Center, Comprehensive Breast
Center, Cancer Genetics, Cardiology
Services, Colorectal Services, Dialysis
Center, Head and Neck Cancer, Kidney
Transplant, Melanoma Services,
Minimally Invasive Surgery, Nasal Sinus
Services, Neurosurgical Services,
Obstetrics, Orthopedics, Prostate
Cancer, Radiology and Imaging Services,
Rehab Services, Sleep Disorder Center,
Thoracic Oncology Center and Vascular
Institute.
SJH, SJMC provides a comprehensive
range of services, centers and programs:
Caregiver Resource Center, Chronic Pain
Center, Community Outreach Services,
Critical Care, Diabetes Management,
Ears, Nose and Throat, Emergency
Services, Endoscopy, Fetal Diagnostic
Center, Gastroenterology, Home Health
Services, Hospice Care Services,
Imaging, Laboratory, Lymphedema,
Minimally Invasive Surgery, Neurology
and Neurosurgical Services,
Ophthalmology, Palliative Care,
Pathology, Radiology, Robotic Surgery,
Senior Services, Sleep Disorders
Institute, Speech Therapy, Surgery,
Transitional Care Center, Urology,
Wellness and Fitness, Wound Care
For more information go
to:
http://www.sjo.org/
St. Joseph Health, St. Jude
Medical Center*
101 E. Valencia Drive,
Fullerton, CA 92835
to:
http://www.stjudemedic
alcenter.org/
Page 23
Appendix 3b (continued)
Other Facilities that provide healthcare in Southern California, affiliated with St.
Joseph Health
The following are other facilities providing health care in Orange County region. This list is not
exhaustive.
Organization
St. Joseph Health, Mission
Hospital
Address
Mission Viejo:
27700 Medical Center
Road Mission Viejo, CA
92691
to:
http://www.mission4heal
th.com/
Laguna Beach:
31872 Coast Highway
Laguna Beach, CA 92651
to:
http://www.mission4heal
th.com/ForVisitors/VisitorInformation/LagunaBeach.aspx
Description
Mission Viejo: Services include 24-hour
emergency care; Mission Imaging Center
offering the most advanced diagnostic
care, Mission Heart Center providing
cardiac rehabilitation and chest pain
center; Mission Stroke Center, providing
the region's most comprehensive and
advanced neurological care; Mission
Maternity Center including special care
for high risk pregnancy; and Mission
Women's Wellness Center offering
comprehensive breast, heart and pelvic
care. Mission Hospital also offers the
highest level of care in orthopedics,
rehabilitation, cancer, spine and vascular
services.
Laguna Beach: Services include 24-hour
emergency, intensive and medical-surgical
care as well as behavioral health and
chemical and pain medication
dependency treatment.
Page 24
Appendix 4: St. Joseph Health, St. Mary Community Benefit Committee Roster
Name
Organization
Expertise
Ms. Rosella Bernal
East-West/Desert Community Bank
Hospital Board of Trustees, Business
Leader, Local resident Apple Valley
Health Advocate, Local resident
Victorville
Ms. Margaret Cooker
Retired Nurse
Ms. Corie Lopez
Institute for Public Strategies
Community Organizer
Ms. Meaghan Ellis
Public Health Clinics
Mr. Eric Moreno
Victor Valley Community Services
Dental Program
Hospital Board of Trustee, Dental Health
Advocate for the poor, local resident
Ms. Mary O Toole
San Bernardino County, Chief
Executive Office
Health Advocate, Local resident Hesperia
Ms. Marlene Turner
Inland Empire Health Plan
Health advocate for Medi-Cal population
Brother Ignatius Sudol
Charlie Glasper
Retired Air Force
Chair, Hospital Board of Trustees, senior
care, substance abuse, Care for the Poor
Local resident, Adelanto
Brother Stephen de la
Rosa
Hospital Board of Trustees, senior care,
substance abuse, care for the poor
Sister Martha Ann
Fitzpatrick
Sister of St. Joseph of Orange
Mission, Advocacy, Care for the Poor
Sister Theresa
LaMetterey
Sister of St. Joseph of Orange
Mission, Advocacy, Care for the Poor
Ms. Wanda Wilborn,
MD
Ms. Glenda Bates
Physician
OBGYN, Care for the Poor
San Bernardino County s Women,
Infant and Children s Program (WIC)
Women and baby, breastfeeding
Mr. Jack Hamilton
High Desert Church
Spiritual Care, Care For The Poor, local
resident Phelan
Mr. Alan Garrett
St. Joseph Health System
President and CEO of Hospital
Administration, Advocacy
Mr. John PerringMulligan
Mission, Social Justice, Care For The Poor,
local resident
Ms. Laurie Roberts
Maternal child, Women s Health,
Diabetes, Care for the Poor
Mr. Kevin Mahany
Advocacy, Community Organizing, local
resident
Page 25
Appendix 5:
2011 PRC Community Health Report: Community Health Findings Greater High
Desert Region, Inland Empire North Region of San Bernardino County
2011 PRC
Community
Health Report
Sponsored by
St. Mary Medical Center
Apple Valley, California
11326 “P” Street  Omaha, Nebraska 68137-2316
(800) 428-7455  www.prconline.com  2010-0792-02  © PRC, 2011.
Table Of Contents
INTRODUCTION
5
Project Overview ................................................................................................... 6
Project Goals
Methodology
6
6
Summary of Findings .......................................................................................... 11
Areas of Opportunity for Community Health Improvement
Summary Tables: Comparisons With Benchmark Data
GENERAL HEALTH STATUS
11
12
25
Overall Health Status .......................................................................................... 26
Self-Reported Health Status
26
28
Mental Health & Mental Disorders .................................................................... 31
Mental Health Status
Depression
Stress
Suicide
Mental Health Treatment
Children & ADD/ADHD
DEATH, DISEASE & CHRONIC CONDITIONS
32
33
35
37
38
39
40
Leading Causes of Death .................................................................................... 41
Distribution of Deaths by Cause
Age-Adjusted Death Rates for Selected Causes
41
41
Cardiovascular Disease ....................................................................................... 43
Age-Adjusted Heart Disease & Stroke Deaths
Prevalence of Heart Disease & Stroke
Stroke Symptom Awareness
Cardiovascular Risk Factors
43
47
48
50
Cancer ................................................................................................................... 57
Age-Adjusted Cancer Deaths
Prevalence of Cancer
Cancer Screenings
57
60
61
Respiratory Disease ............................................................................................. 67
Age-Adjusted Respiratory Disease Deaths
Prevalence of Respiratory Conditions
68
71
Injury & Violence ................................................................................................. 74
Leading Causes of Accidental Death
Unintentional Injury
Intentional Injury (Violence)
75
75
83
Diabetes ................................................................................................................ 90
Age-Adjusted Diabetes Deaths
Prevalence of Diabetes
Diabetes Treatment
90
92
93
Alzheimers Disease ............................................................................................ 94
Age-Adjusted Alzheimer's Disease Deaths
94
Kidney Disease ..................................................................................................... 96
Age-Adjusted Kidney Disease Deaths
96
2
Potentially Disabling Conditions ....................................................................... 98
Arthritis, Osteoporosis, & Chronic Pain
Vision & Hearing Impairment
INFECTIOUS DISEASE
98
102
104
Vaccine-Preventable Conditions ...................................................................... 105
Measles, Mumps, Rubella
Pertussis
Acute Hepatitis C
105
106
106
Influenza & Pneumonia Vaccination ................................................................ 108
Flu Vaccinations
Pneumonia Vaccination
108
109
Tuberculosis........................................................................................................ 111
HIV ....................................................................................................................... 113
Age-Adjusted HIV/AIDS Deaths
HIV Testing
113
115
Sexually Transmitted Diseases ......................................................................... 116
Gonorrhea
Syphilis
Chlamydia
Acute Hepatitis B
Safe Sexual Practices
BIRTHS
117
118
119
120
122
124
Prenatal Care ...................................................................................................... 125
Birth Outcomes & Risks ..................................................................................... 127
Low-Weight Births
C-Sections
Infant Mortality
Risk Factors
127
128
129
130
Family Planning ................................................................................................. 132
Births to Teen Mothers
MODIFIABLE HEALTH RISKS
132
134
Actual Causes Of Death..................................................................................... 135
Nutrition ............................................................................................................. 136
Daily Recommendation of Fruits/Vegetables
Health Advice About Diet & Nutrition
137
139
Physical Activity ................................................................................................. 140
Level of Activity at Work
Leisure-Time Physical Activity
Activity Levels
Health Advice About Physical Activity & Exercise
Children's Screen Time
141
142
143
145
146
Weight Status ..................................................................................................... 147
Adult Weight Status
Weight Management
Childhood Overweight & Obesity
Perception of Child's Weight
Child's Weight Status
147
152
154
154
155
3
Substance Abuse ................................................................................................ 157
Age-Adjusted Cirrhosis/Liver Disease Deaths
High-Risk Alcohol Use
Age-Adjusted Drug-Induced Deaths
Illicit Drug Use
Alcohol & Drug Treatment
158
159
162
164
164
Tobacco Use ........................................................................................................ 165
Cigarette Smoking
Other Tobacco Use
ACCESS TO HEALTH SERVICES
165
171
172
Health Insurance Coverage ............................................................................... 173
Type of Healthcare Coverage
Lack of Health Insurance Coverage
173
175
Difficulties Accessing Healthcare .................................................................... 177
Difficulties Accessing Services
Barriers to Healthcare Access
Prescriptions
Accessing Healthcare for Children
177
178
179
180
Primary Care Services ........................................................................................ 181
Specific Source of Ongoing Care
Utilization of Primary Care Services
181
183
Emergency Room Utilization ............................................................................ 185
Oral Health ......................................................................................................... 186
Dental Care
Dental Insurance
187
189
Vision Care ......................................................................................................... 190
HEALTH EDUCATION & OUTREACH
191
Healthcare Information Sources ...................................................................... 192
Participation in Health Promotion Events ...................................................... 193
PERCEPTIONS OF HEALTHCARE
195
Ratings of Local Healthcare Services ............................................................... 196
4
INTRODUCTION
The PRC Community Health Assessment is a systematic,
data-driven approach to determining the health status,
behaviors and needs of our community residents.
5
Project Overview
Project Goals
This Community Health Assessment is a systematic, data-driven approach to
determining the health status, behaviors and needs of residents in the primary and
secondary service areas of St. Mary Medical Center. Subsequently, this information
may be used to inform decisions and guide efforts to improve community health
and wellness.
A PRC Community Health Assessment provides the information so that communities
may identify issues of greatest concern and decide to commit resources to those
areas, thereby making the greatest possible impact on community health status.
This Community Health Assessment will serve as a tool toward reaching three basic
goals:
 To improve residents health status, increase their life spans, and
elevate their overall quality of life. A healthy community is not only
one where its residents suffer little from physical and mental illness, but also
one where its residents enjoy a high quality of life.
 To reduce the health disparities among residents. By gathering
demographic information along with health status and behavior data, it will
be possible to identify population segments that are most at-risk for various
diseases and injuries. Intervention plans aimed at targeting these individuals
may then be developed to combat some of the socio-economic factors which
have historically had a negative impact on residents' health.
 To increase accessibility to preventive services for all community
residents. More accessible preventive services will prove beneficial in
accomplishing the first goal (improving health status, increasing life spans,
and elevating the quality of life), as well as lowering the costs associated
with caring for late-stage diseases resulting from a lack of preventive care.
Methodology
This assessment incorporates data from primary research (the 2011 PRC Community
Health Survey) and secondary research (vital statistics and other existing healthrelated data). It also allows for comparison to benchmark data at the state and
national levels.
2011 PRC Community Health Survey
Survey Instrument
The survey instrument used for this study is based largely on the Centers for Disease
Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS), as
well as various other public health surveys and customized questions addressing
gaps in indicator data relative to health promotion and disease prevention
objectives and other recognized health issues. The final survey instrument was
developed by St. Mary Medical Center and Professional Research Consultants (PRC).
6
Community Defined for This Assessment
The “community” defined for this assessment is made up of St. Mary Medical
Center's Primary Service Area (comprised of the Apple Valley, Hesperia, and
Victorville communities) and remaining surrounding communities (Secondary Service
Area). Each of these is defined at the ZIP Code level. Throughout the text, the
combined area will be referred to as the Total Area.
A geographical description of the Total Area is illustrated in the following map.
Sample Approach & Design
A precise and carefully executed methodology is critical in asserting the validity of
the results gathered in the 2011 PRC Community Health Survey. Thus, to ensure the
best representation of the population surveyed, a telephone interview methodology
was employed. The primary advantages of telephone interviewing are timeliness,
efficiency and random-selection capabilities.
The sample design used for this effort consisted of a stratified random sample of
400 individuals age 18 and older in the Total Area, including 100 interviews each in
the communities of Apple Valley, Hesperia and Victorville (300 total in the Primary
Service Area) and 100 in the Secondary Service Area ZIP Codes. All administration of
the surveys, data collection and data analysis was conducted by Professional
Research Consultants, Inc. (PRC).
7
Sampling Error
For statistical purposes, the maximum rate of error associated with a sample size of
400 respondents is ±4.9% at the 95 percent level of confidence.
Expected Error Ranges for a Sample of 400
Respondents at the 95 Percent Level of Confidence
±6.0
±5.0
±4.0
±3.0
±2.0
±1.0
±0.0
0%
Note:
Examples:
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
„ The "response rate" (the percentage of a population giving a particular response) determines the error rate associated with that response.
A "95 percent level of confidence" indicates that responses would fall within the expected error range on 95 out of 100 trials.
„ If 10% of the sample of 400 respondents answered a certain question with a "yes," it can be asserted that between 7.1% and 12.9% (10% ± 2.9%)
of the total population would offer this response.
„ If 50% of respondents said "yes," one could be certain with a 95 percent level of confidence that between 45.1% and 54.9% (50% ± 4.9%)
of the total population would respond "yes" if asked this question.
Sample Characteristics
To accurately represent the population studied, PRC strives to minimize bias through
application of a proven telephone methodology and random-selection techniques.
And, while this random sampling of the population produces a highly representative
sample, it is a common and preferred practice to “weight” the raw data to improve
this representativeness even further. This is accomplished by adjusting the results of
a random sample to match the geographic distribution and demographic
characteristics of the population surveyed (poststratification), so as to eliminate any
naturally occurring bias. Specifically, once the raw data are gathered, respondents
are examined by key demographic characteristics (namely gender, age, race,
ethnicity, and poverty status) and a statistical application package applies weighting
variables that produce a sample which more closely matches the population for
these characteristics. Thus, while the integrity of each individual's responses is
maintained, one respondent's responses may contribute to the whole the same
weight as, for example, 1.1 respondents. Another respondent, whose demographic
characteristics may have been slightly oversampled, may contribute the same weight
as 0.9 respondents.
The following charts outline the characteristics of the Total Area sample for key
demographic variables, compared to actual population characteristics revealed in
census data. [Note that the sample consisted solely of area residents age 18 and
older; data on children were given by proxy by the person most responsible for that
child's healthcare needs, and these children are not represented demographically in
this chart.]
8
Population & Sample Characteristics
(Total Area, 2011)
100%
Actual Population
Weighted Survey Sample
39.8%
37.8%
15.8%
37.6%
15.9%
20%
15.1%
15.5%
40%
37.6%
46.6%
46.5%
39.9%
39.4%
45.4%
44.7%
50.8%
50.4%
49.6%
60%
49.2%
80%
0%
Men
Sources:
Women
18 to 39
40 to 64
65+
White
Hispanic
Other
<200% FPL
 Census 2000, Summary File 3 (SF 3). US Census Bureau.
 PRC Community Health Survey, Professional Research Consultants, Inc.
Further note that the poverty descriptions and segmentation used in this report are
based on administrative poverty thresholds determined by the US Department of
Health & Human Services. These guidelines define poverty status by household
income level and number of persons in the household (e.g., the 2011 guidelines
place the poverty threshold for a family of four at $22,350 annual household income
or lower). In sample segmentation: “<200% FPL” (or less than twice the Federal
Poverty Level) refers to community members living in a household with defined
poverty status, along with those households living just above the poverty level,
earning up to twice the poverty threshold; and “200%+” refers to those households
living on incomes which are twice or more the federal poverty level.
The sample design and the quality control procedures used in the data collection
ensure that the sample is representative. Thus, the findings may be generalized to
the total population of community members in the defined area with a high degree
of confidence.
Public Health, Vital Statistics & Other Data
A variety of existing (secondary) data sources was consulted to complement the
research quality of this Community Health Assessment. Data for San Bernadino
County were obtained from the following sources (specific citations are included
with the graphs throughout this report):
 California Department of Public Health
 Center for Social Services Research, University of Berkeley
 California Department of Justice
 Centers for Disease Control & Prevention
 ESRI BIS Demographic Portfolio (Projections Based on the US Census)
 FBI, Crime in the United States
 National Center for Health Statistics
Note that secondary data reflect county-level data.
9
Benchmark Data
California Risk Factor Data
Statewide risk factor data are provided where available as an additional benchmark
against which to compare local survey findings; these data are reported in the most
recent BRFSS (Behavioral Risk Factor Surveillance System) Prevalence and Trend Data
published by the Centers for Disease Control and Prevention and the US Department
of Health & Human Services. State-level vital statistics are also provided for
comparison of secondary data indicators.
Nationwide Risk Factor Data
Nationwide risk factor data, which are also provided in comparison charts, are taken
from the 2011 PRC National Health Survey; the methodological approach for the
national study is identical to that employed in this assessment, and these data may
be generalized to the US population with a high degree of confidence. Nationallevel vital statistics are also provided for comparison of secondary data indicators.
Healthy People 2020
Healthy People provides science-based, 10-year national
objectives for improving the health of all Americans.
The Healthy People initiative is grounded in the
principle that setting national objectives and monitoring
progress can motivate action. For three decades,
Healthy People has established benchmarks and monitored progress over time in
order to:
 Encourage collaborations across sectors.
 Guide individuals toward making informed health decisions.
 Measure the impact of prevention activities.
Healthy People 2020 is the product of an extensive stakeholder feedback process
that is unparalleled in government and health. It integrates input from public
health and prevention experts, a wide range of federal, state and local government
officials, a consortium of more than 2,000 organizations, and perhaps most
importantly, the public. More than 8,000 comments were considered in drafting a
comprehensive set of Healthy People 2020 objectives.
10
Summary of Findings
Areas of Opportunity for Community Health Improvement
The following “health priorities” represent recommended areas of intervention,
based on the information gathered through this Community Health Assessment and
the guidelines set forth in Healthy People 2020. From these data, opportunities for
health improvement exist in the region with regard to the following health areas
(see also the summary tables presented in the following section). These areas of
concern are subject to the discretion of area providers, the steering committee, or
other local organizations and community leaders as to actionability and priority.
Areas of Opportunity Identified Through This Assessment


Lack of Insurance/Insurance Instability



Cancer Deaths (Lung, Prostate, Female Breast, Colorectal)
Diabetes Deaths
Disability



Dementias

Alzheimer's Disease Deaths
Education

Attendance at Health Promotion Events
Family Planning

Births to Teens






Heart Disease & Stroke Deaths



Prenatal Care
Nutrition & Overweight


Fruit & Vegetable Consumption
Oral Health

Dental Visits (Adults)
Respiratory Disease


Chronic Lower Respiratory Disease Deaths
Substance Abuse

Cirrhosis/Liver Disease Deaths
Vision


Blindness/Trouble Seeing
Access to Healthcare
Cancer
Diabetes
Injury & Violence
Maternal & Infant Health
Difficulty Accessing Healthcare Services (Adults & Children);
Barriers to Healthcare Access (Cost, Transportation, Hours, Etc.)
Perceptions of Local Healthcare Services
Diabetes Prevalence
Hypertension
Motor Vehicle Crash Deaths
Homicides
Violent Crime, Including Domestic Violence
Low Birth-weight
Infant Mortality
Overweight/Obesity
Routine Vision Care
11
Summary Tables: Comparisons With Benchmark Data
The following tables provide an overview of indicators in the Total Area, including
comparisons among the individual communities. These data are grouped to
correspond with the Focus Areas presented in Healthy People 2020.
Reading the Summary Tables
 In the following charts, Total Area results are shown in the larger, blue column.
 The yellow columns [to the far left of the Total Area column] provide comparisons
among the three communities comprising the Primary Service Area, identifying
differences for each as “better than” (B
B), “worse than” (h
h), or “similar to” (d) the
combined opposing communities.
 The green columns [to the immediate left of the Total Area column] provide
comparisons between the Primary and Secondary Service Areas, again identifying
differences for each as “better than” (B
B), “worse than” (h
h), or “similar to” (d) the
other.
 The columns to the right of the Total Area column provide comparisons between
the Total Area and any available state and national findings, and Healthy People
2020 targets. Again, symbols indicate whether the Total Area compares favorably
(B
B), unfavorably (h
h), or comparably (d) to these external data.
Note that blank table cells signify that data are not available or are not reliable for
that area and/or for that indicator.
12
Each City vs. Others
Access to Health Services
% [Age 18-64] Lack Health Insurance
PSA vs. SSA
Apple
Valley
Hesperia
Victorville
PSA
SSA
d
d
d
d
d
19.9
18.0
18.1
18.5
TOTAL
AREA
19.5
23.9
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
d
19.6
59.6
% [65+] With Medicare Supplement Insurance
d
14.9
h
0.0
h
75.5
% [Insured] Insurance Covers Prescriptions
% [Insured] Went Without Coverage in Past Year
d
% Inconvenient Hrs Prevented Dr Visit in Past Year
% Cost Prevented Getting Prescription in Past Year
% Cost Prevented Physician Visit in Past Year
93.9
B
d
d
d
d
10.3
14.6
9.1
9.7
4.8
51.7
38.4
48.9
56.5
d
h
d
B
d
d
17.2
d
B
d
17.0
10.8
16.7
19.3
d
d
d
d
d
21.5
20.4
16.9
20.8
24.4
d
d
d
d
d
18.6
d
24.6
d
15.8
d
13.2
d
19.1
d
d
d
d
18.5
d
32.4
d
B
16.0
d
14.8
12.7
d
d
10.5
d
18.8
8.9
d
16.1
16.9
d
24.1
d
14.4
d
11.7
d
17.6
h
14.3
27.6
13.3
h
37.3
25.7
17.5
h
13.3
62.2
h
d
93.9
50.4
17.8
% Skipped Prescription Doses to Save Costs
95.1
95.4
16.6
% Transportation Hindered Dr Visit in Past Year
d
95.0
26.7
% Difficulty Finding Physician in Past Year
d
93.8
21.8
% Difficulty Getting Appointment in Past Year
d
97.8
4.2
% Difficulty Accessing Healthcare in Past Year (Composite)
d
h
15.0
h
26.5
14.0
h
26.9
16.5
h
22.1
10.7
h
19.9
7.7
d
25.9
14.8
6.5
% Difficulty Getting Child's Healthcare in Past Year
h
1.9
% [Age 18+] Have a Specific Source of Ongoing Care
d
78.5
% [Age 18-64] Have a Specific Source of Ongoing Care
d
75.1
d
74.2
d
72.0
d
71.4
d
68.8
d
74.2
d
71.4
d
72.7
d
70.1
d
66.0
76.3
d
64.5
75.1
82.3
% [Age 65+] Have a Specific Source of Ongoing Care
d
82.6
% Have Had Routine Checkup in Past Year
B
76.0
d
67.5
d
70.5
B
70.9
h
67.6
h
100.0
d
52.1
67.3
88.3
% Child Has Had Checkup in Past Year
h
89.4
d
87.0
% Two or More ER Visits in Past Year
d
d
10.8
11.6
d
12.3
8.5
15.2
d
d
d
d
d
26.0
16.5
% Rate Local Healthcare "Fair/Poor"
27.4
27.1
d
24.1
d
25.9
h
6.5
h
26.5
Note: In this section, the service areas are compared against one another, and each
city in the PSA is compared against the other two combined. Throughout these
tables, a blank or empty cell indicates that data are not available for this indicator or
that sample sizes are too small to provide meaningful results.
15.3
B
better
d
similar
h
worse
13
Arthritis, Osteoporosis & Chronic Back Conditions
% [50+] Arthritis/Rheumatism
% [50+] Osteoporosis
% Sciatica/Chronic Back Pain
% Migraine/Severe Headaches
% Chronic Neck Pain
Apple
Valley
####
#
46.1
####
#
13.9
PSA vs. SSA
Hesperia
Victorville
####
####
42.9
32.2
####
####
11.3
12.7
TOTAL
AREA
PSA
SSA
###
#
39.8
###
#
12.6
##
##
36.6
##
##
5.1
39.2
11.3
20.5
27.1
24.2
20.3
d
d
d
d
d
d
19.2
10.5
d
d
17.4
21.1
20.6
19.9
15.8
d
d
d
d
d
12.9
12.8
6.2
10.1
Cancer
Cancer (Age-Adjusted Death Rate)
Lung Cancer (Age-Adjusted Death Rate)
Prostate Cancer (Age-Adjusted Death Rate)
Female Breast Cancer (Age-Adjusted Death Rate)
Colorectal Cancer (Age-Adjusted Death Rate)
% Skin Cancer
Apple
Valley
####
#
x
####
#
x
####
#
x
####
#
x
####
#
x
d
8.5
% Cancer (Other Than Skin)
% [Men 50+] Prostate Exam in Past 2 Years
% [Women 40+] Mammogram in Past 2 Years
% [Women 50-74] Mammogram in Past 2 Years
% [Women 21-65] Pap Smear in Past 3 Years
% [Age 50+] Sigmoid/Colonoscopy Ever
% [Age 50+] Blood Stool Test in Past 2 Years
d
7.0
####
#
81.0
####
#
68.5
####
#
68.9
####
#
90.3
####
#
62.3
####
#
56.5
Hesperia
Victorville
####
####
x
x
####
####
x
x
####
####
x
x
####
####
x
x
####
####
x
d
5.9
TOTAL
AREA
184.3
x
##
##
x
##
##
x
##
##
x
##
##
x
##
##
x
d
d
d
7.2
d
4.1
d
####
####
79.3
73.0
####
####
81.4
77.3
####
####
80.0
76.5
####
####
97.3
87.1
####
####
61.2
75.6
####
####
44.3
59.7
1.5
B
better
###
#
x
###
#
x
###
#
x
###
#
x
###
#
x
d
4.9
d
4.3
###
#
77.3
###
#
75.8
###
#
74.9
###
#
91.3
###
#
66.9
###
#
53.9
d
8.3
SSA
7.3
d
16.9
PSA
7.7
h
164.2
46.0
h
40.4
31.0
h
23.0
26.7
h
22.4
17.5
d
similar
h
worse
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
h
15.5
d
181.0
B
51.6
h
23.9
h
23.5
d
17.2
h
160.6
d
45.5
h
21.2
h
20.6
h
14.5
d
6.7
3.0
##
##
77.8
##
##
77.9
##
##
82.3
##
##
84.5
##
##
67.9
##
##
41.8
5.3
d
12.4
PSA vs. SSA
h
21.5
B
27.6
24.1
d
d
35.4
23.5
d
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
8.1
d
5.5
77.4
d
70.5
76.2
d
78.9
76.6
d
83.0
90.2
B
84.1
67.1
B
59.8
51.6
B
27.8
B
better
d
74.8
d
79.9
d
84.7
d
81.1
d
93.0
d
72.0
B
28.3
d
similar
h
worse
14
Chronic Kidney Disease
Kidney Disease (Age-Adjusted Death Rate)
Apple
Valley
####
#
x
PSA vs. SSA
Hesperia
Victorville
####
####
x
x
PSA
SSA
###
#
x
##
##
x
TOTAL
AREA
11.7
Diabetes
Diabetes Mellitus (Age-Adjusted Death Rate)
% Diabetes/High Blood Sugar
% [Diabetics] Taking Insulin/Medication
Apple
Valley
####
#
x
d
12.9
####
#
86.9
PSA vs. SSA
Hesperia
Victorville
####
####
x
d
B
better
TOTAL
AREA
PSA
SSA
##
##
x
32.0
x
###
#
x
d
d
d
14.2
13.3
12.9
####
####
77.5
82.3
13.0
###
#
81.9
19.2
##
##
75.8
Dementias, Including Alzheimer's Disease
Alzheimer's Disease (Age-Adjusted Death Rate)
Apple
Valley
####
#
x
PSA vs. SSA
Hesperia
Victorville
####
####
x
x
PSA
SSA
###
#
x
##
##
x
Educational & Community-Based Programs
% Attended Health Event in Past Year
Apple
Valley
Hesperia
Victorville
PSA
SSA
d
d
d
B
h
14.0
11.1
15.8
13.7
Family Planning
% Births to Teenagers
Apple
Valley
####
#
x
Victorville
####
####
x
x
PSA
SSA
###
#
x
##
##
x
d
similar
h
worse
h
23.5
h
19.6
h
10.1
d
77.7
B
better
TOTAL
AREA
28.4
h
24.0
B
better
TOTAL
AREA
d
similar
h
worse
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
h
22.7
d
similar
h
worse
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
11.9
h
4.0
PSA vs. SSA
Hesperia
h
80.4
22.2
h
9.1
Each Sub-Area vs. Others
B
14.5
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
22.5
h
8.0
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
B
better
TOTAL
AREA
12.4
d
similar
h
worse
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
h
9.3
B
better
h
10.4
d
similar
h
worse
15
General Health Status
% "Fair/Poor" Physical Health
% Activity Limitations
PSA vs. SSA
Apple
Valley
Hesperia
Victorville
PSA
SSA
d
B
d
d
d
20.8
24.4
23.4
13.3
24.0
20.3
23.2
d
d
d
d
d
32.9
22.2
18.9
% Deafness/Trouble Hearing
23.7
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
d
19.6
h
27.9
17.2
better
Hearing & Other Sensory or Communication Disorders
TOTAL
AREA
PSA vs. SSA
Apple
Valley
Hesperia
Victorville
PSA
SSA
d
d
d
d
d
7.3
11.2
5.9
8.0
B
TOTAL
AREA
h
17.0
d
similar
h
worse
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
9.3
d
15.2
d
16.8
9.6
B
better
d
similar
h
worse
16
Diseases of the Heart (Age-Adjusted Death Rate)
% Heart Attack
Stroke (Age-Adjusted Death Rate)
% Angina/Coronary Heart Disease
Apple
Valley
####
#
x
d
% Told Have High Blood Pressure (Ever)
% [HBP] Taking Action to Control High Blood Pressure
% Cholesterol Checked in Past 5 Years
% Told Have High Cholesterol (Ever)
% [HBC] Taking Action to Control High Blood Cholesterol
% 1+ Cardiovascular Risk Factor
d
d
d
4.9
2.2
d
4.5
d
2.3
5.3
4.9
##
##
x
49.5
x
4.9
###
#
x
d
d
d
3.5
d
5.7
d
3.8
2.7
d
6.0
d
5.3
3.4
d
5.8
d
4.0
3.7
2.6
d
d
d
d
d
d
37.1
42.2
####
#
86.9
35.4
36.5
####
####
97.4
87.5
37.6
###
#
90.2
34.7
##
##
88.4
89.9
d
90.1
90.0
90.5
d
d
d
d
d
30.4
31.6
####
#
92.6
d
d
d
B
d
d
d
d
82.7
27.0
29.1
####
####
90.0
86.4
d
83.5
d
80.8
d
83.4
d
64.8
d
44.7
d
78.3
d
58.3
d
91.3
d
83.0
d
75.3
d
78.0
d
61.4
d
48.4
d
81.3
d
56.7
d
82.9
d
29.0
###
#
89.2
d
81.7
B
78.6
d
81.4
B
66.4
d
48.2
d
80.2
d
58.3
h
85.6
44.2
d
d
h
33.8
4.2
d
d
d
2.7
d
h
d
34.3
d
94.9
h
26.9
d
89.1
90.5
d
h
45.1
25.7
89.4
d
h
3.6
94.7
89.6
d
d
2.3
92.8
d
d
h
152.7
6.1
95.8
d
h
200.9
4.9
94.5
d
h
189.9
3.1
97.7
d
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
3.3
95.7
61.2
% Would Call 911 if Someone Having Heart Attack/Stroke
3.9
95.3
80.5
% Perceive Sign of Stroke: Severe Headache/No Cause
d
d
52.3
% Perceive Sign of Stroke: Trouble Walking/Dizzy
x
d
76.3
% Perceive Sign of Stroke: Chest Pain/Discomfort
##
##
x
252.6
x
###
#
x
x
84.1
% Perceive Sign of Stroke: Sudden Trouble Seeing
####
####
80.9
% Perceive Sign of Stroke: Numbness/Weak on One Side
SSA
####
77.4
% Perceive Sign of Stroke: Confusion/Trouble Speaking
####
TOTAL
AREA
PSA
d
4.2
% Blood Pressure Checked in Past 2 Years
Victorville
d
7.2
% Stroke
Hesperia
5.6
####
#
x
6.0
% Heart Disease (Heart Attack, Angina, Coronary Disease)
PSA vs. SSA
B
74.5
36.5
##
##
85.3
88.4
d
82.7
h
76.3
d
80.0
h
62.7
d
48.9
d
78.4
d
56.7
B
86.9
B
36.5
d
90.7
d
31.4
B
82.1
h
13.5
d
89.1
d
87.1
86.3
65.8
73.8
46.7
51.9
70.7
49.0
92.8
B
better
d
similar
h
worse
17
HIV
HIV (Age-Adjusted Death Rate)
% Ever Tested for HIV
Apple
Valley
####
#
x
d
% [Age 18-64] Ever Tested for HIV
% [Age 18-44] HIV Test in the Past Year
Hesperia
Victorville
####
####
x
x
d
48.0
47.8
d
49.3
####
#
22.1
PSA vs. SSA
d
d
52.5
d
51.8
56.7
####
####
13.7
19.0
TOTAL
AREA
PSA
SSA
###
#
x
##
##
x
3.4
d
49.3
d
52.9
d
49.8
d
53.2
###
#
18.2
Immunization & Infectious Diseases
Measles per 100,000
Mumps per 100,000
Rubella per 100,000
Pertussis per 100,000
Hepatitis C, non-A non-B Incidence per 100,000
% [Age 65+] Flu Shot in Past Year
% [High-Risk 18-64] Flu Shot in Past Year
% [Age 65+] Pneumonia Vaccine Ever
% [High-Risk 18-64] Pneumonia Vaccine Ever
Tuberculosis Incidence per 100,000
% Ever Vaccinated for Hepatitis B
Apple
Valley
####
#
x
####
#
x
####
#
x
####
#
x
####
#
x
####
#
67.6
####
#
58.0
####
#
65.6
####
#
47.8
####
#
x
51.9
##
##
21.2
d
39.2
Victorville
####
####
x
x
####
####
x
x
####
####
x
x
####
####
x
x
####
####
x
x
####
####
35.9
75.5
####
####
37.3
36.9
####
####
69.6
60.1
####
####
18.0
38.7
####
####
x
x
d
40.5
d
35.8
PSA
SSA
###
#
x
###
#
x
###
#
x
###
#
x
###
#
x
###
#
61.3
###
#
42.3
###
#
64.5
###
#
33.7
###
#
x
##
##
x
##
##
x
##
##
x
##
##
x
##
##
x
##
##
67.8
##
##
39.6
##
##
61.0
##
##
35.3
##
##
x
d
38.2
d
4.6
d
3.3
49.7
d
55.5
18.8
d
19.9
B
better
TOTAL
AREA
0.0
d
d
B
B
d
d
B
B
B
B
0.0
0.0
0.2
0.0
0.0
0.4
2.1
0.0
0.1
62.4
d
similar
d
65.1
41.8
0.9
0.0
4.4
0.4
d
71.6
d
d
59.9
34.0
3.5
h
worse
0.0
52.5
64.0
d
16.9
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
d
68.1
d
B
7.2
39.5
B
0.2
h
90.0
h
90.0
h
90.0
h
32.0
60.0
B
h
4.4
1.0
d
45.7
B
d
47.1
PSA vs. SSA
Hesperia
B
4.0
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
38.4
B
better
d
similar
h
worse
18
Injury & Violence Prevention
Unintentional Injury (Age-Adjusted Death Rate)
Motor Vehicle Crashes (Age-Adjusted Death Rate)
% "Always" Wear Seat Belt
% Child [Age 5-17] "Always" Uses Seat Belt
% Child [Age 0-17] "Always" Uses Seat Belt/Car Seat
% Child [Age 5-17] "Always" Wears Bicycle Helmet
Firearm-Related Deaths (Age-Adjusted Death Rate)
% Firearm in Home
% [Homes With Children] Firearm in Home
% [Homes With Firearms] Weapon(s) Unlocked & Loaded
Homicide (Age-Adjusted Death Rate)
Violent Crime per 100,000
% Victim of Violent Crime in Past 5 Years
Domestic Violence Offenses per 100,000
% Ever Threatened With Violence by Intimate Partner
% Victim of Domestic Violence (Ever)
Child Abuse Offenses per 100,000
Apple
Valley
####
#
x
####
#
x
d
94.4
####
#
91.3
####
#
92.3
####
#
42.9
####
#
x
d
34.8
####
#
33.0
####
#
9.3
####
#
x
####
#
x
d
PSA vs. SSA
Hesperia
Victorville
####
####
x
x
####
####
x
d
PSA
SSA
##
##
x
##
##
x
32.0
x
###
#
x
###
#
x
d
d
d
94.0
92.5
95.8
####
####
96.5
97.3
####
####
94.6
98.3
####
####
43.7
43.4
####
####
x
x
d
d
33.4
29.7
####
####
25.8
25.2
####
####
16.5
15.5
####
####
x
x
94.4
###
#
95.0
###
#
96.3
###
#
43.3
###
#
x
d
####
####
x
x
32.2
###
#
27.7
###
#
14.1
###
#
x
###
#
x
d
4.2
####
#
x
d
d
####
####
x
B
d
3.9
2.0
92.3
##
##
90.5
##
##
92.5
##
##
48.9
##
##
x
d
25.6
##
##
17.2
##
##
25.7
##
##
x
##
##
x
d
16.7
h
21.1
19.0
####
####
x
x
18.7
###
#
x
30.5
##
##
x
d
35.3
11.2
h
9.2
31.1
h
10.3
h
9.2
B
37.9
25.8
B
34.4
15.8
d
16.9
8.7
h
6.7
500.9
d
503.7
3.1
20.9
B
d
44.3
19.2
d
d
92.4
91.6
d
d
h
12.4
d
95.6
d
d
B
36.0
91.6
d
21.8
h
14.3
B
94.1
x
18.7
h
B
39.7
85.3
401.4
22.6
d
11.7
2.4
##
##
x
19.3
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
31.8
3.2
###
#
x
11.8
15.3
####
#
x
TOTAL
AREA
h
6.1
h
5.5
h
465.0
d
1.6
B
490.5
h
11.7
h
13.5
57.7
h
48.4
B
better
d
similar
h
worse
19
Maternal, Infant & Child Health
% Late (3rd Trimester) or No Prenatal Care
% of Low Birthweight Births
Infant Death Rate
% Births to Mothers With Low Educational Attainment
% of Deliveries by C-Section
Apple
Valley
####
#
x
####
#
x
####
#
x
####
#
x
####
#
x
PSA vs. SSA
Hesperia
Victorville
####
####
x
x
####
####
x
x
####
####
x
x
####
####
x
x
####
####
x
x
PSA
SSA
###
#
x
###
#
x
###
#
x
###
#
x
###
#
x
##
##
x
##
##
x
##
##
x
##
##
x
##
##
x
TOTAL
AREA
3.6
Mental Health & Mental Disorders
% "Fair/Poor" Mental Health
7.2
6.6
29.6
32.3
% Symptoms of Chronic Depression (2+ Years)
Suicide (Age-Adjusted Death Rate)
% Have Ever Sought Help for Mental Health
% [Those With Major Depression] Seeking Help
% Typical Day Is "Extremely/Very" Stressful
% Child [Age 5-17] Takes Prescription for ADD/ADHD
TOTAL
AREA
B
13.4
B
11.1
h
13.9
8.0
d
25.9
d
d
d
d
d
11.5
30.6
d
d
d
d
d
23.6
####
#
x
d
30.6
32.0
####
####
x
x
d
d
15.2
####
#
71.5
23.4
23.3
####
####
79.0
d
B
13.6
####
#
1.2
29.4
###
#
x
d
35.9
##
##
x
9.7
d
21.8
d
d
d
10.3
####
####
2.7
d
d
31.7
d
similar
h
worse
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
d
d
d
d
9.4
76.6
14.2
##
##
5.5
h
26.5
76.3
9.5
###
#
1.4
6.0
11.7
24.2
##
##
75.7
10.3
6.9
7.8
11.7
21.2
###
#
76.5
5.2
h
B
d
17.0
d
better
SSA
10.2
h
32.6
PSA
10.5
B
8.2
26.6
Victorville
11.1
B
5.3
Hesperia
8.5
h
6.8
Apple
Valley
11.5
% Major Depression
PSA vs. SSA
h
3.2
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
B
11.1
B
10.2
d
24.4
d
82.0
d
75.1
d
11.5
2.2
B
6.5
B
better
d
similar
h
worse
20
Nutrition & Weight Status
% Eat 5+ Servings of Fruit or Vegetables per Day
% Eat 2+ Servings of Fruit per Day
% Eat 3+ Servings of Vegetables per Day
% Medical Advice on Nutrition in Past Year
% Healthy Weight (BMI 18.5-24.9)
% Overweight
% Obese
% Perceive Self as Somewhat/Very Overweight
% Medical Advice on Weight in Past Year
% [Obese Adults] Counseled About Weight in Past Year
% [Overweights] Trying to Lose Weight Both Diet/Exercise
% Children [Age 5-17] Overweight
% Children [Age 5-17] Obese
% [Parents] Perceive Child [2-17] "Somewhat/Very" Overwt
% [Parents] Have Been Told That Child [2-17] Is Overweight
TOTAL
AREA
Apple
Valley
Hesperia
Victorville
PSA
SSA
d
d
d
d
d
38.9
45.5
35.7
40.5
40.2
33.2
d
d
d
d
d
57.9
50.3
63.1
57.3
60.4
d
d
d
B
h
34.2
33.3
38.3
37.0
21.0
d
d
d
d
d
48.3
44.9
47.4
48.3
48.4
d
d
d
d
d
30.7
31.6
34.2
32.3
23.4
d
d
d
d
d
68.4
68.4
64.0
66.7
76.0
h
d
d
d
d
33.7
29.2
34.2
35.1
27.8
d
d
d
d
d
60.4
54.9
63.6
61.4
56.6
d
d
d
d
d
25.5
d
32.8
d
d
39.3
####
####
27.2
d
d
47.8
####
#
27.2
####
#
16.4
####
#
11.1
####
#
3.9
d
45.1
d
d
d
43.9
####
####
29.3
14.5
####
####
8.0
14.5
####
####
14.9
12.0
####
####
12.7
37.9
##
##
64.2
##
##
29.4
##
##
25.0
##
##
4.9
Oral Health
% [Age 18+] Dental Visit in Past Year
% Child [Age 2-17] Dental Visit in Past Year
% Have Dental Insurance
Apple
Valley
d
Hesperia
d
PSA vs. SSA
Victorville
d
54.2
####
#
95.0
55.7
56.4
####
####
64.5
d
d
56.5
57.8
PSA
d
SSA
d
d
d
d
31.2
d
30.7
16.0
d
18.9
14.9
d
14.6
d
9.9
4.9
d
3.2
B
better
TOTAL
AREA
54.9
77.9
70.1
B
d
d
62.6
d
similar
h
worse
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
h
70.3
h
66.9
d
79.2
B
49.0
B
49.0
d
60.6
B
31.8
38.6
51.8
##
##
84.7
63.0
d
47.4
55.6
###
#
76.3
71.2
d
30.6
30.9
d
28.5
25.7
40.9
45.4
###
#
24.0
###
#
13.1
###
#
12.6
###
#
4.9
d
66.9
d
23.1
27.3
##
##
41.4
50.9
h
d
33.9
55.0
34.3
###
#
40.9
37.4
h
25.5
65.9
25.0
d
61.3
44.3
d
B
31.7
68.6
38.8
####
#
47.4
h
41.9
30.3
26.1
d
40.1
53.9
30.9
h
60.5
39.9
18.7
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
48.8
57.1
27.6
% [Overweights] Counseled About Weight in Past Year
PSA vs. SSA
60.8
B
better
d
similar
h
worse
21
Physical Activity
% [Employed] Job Entails Mostly Sitting/Standing
% No Leisure-Time Physical Activity
Apple
Valley
####
#
68.2
d
22.9
% Meeting Physical Activity Guidelines
% Moderate Physical Activity
d
% Child [Age 5-17] Watches TV 3+ Hours per Day
% Child [Age 5-17] Uses Computer 3+ Hours per Day
####
####
59.8
d
d
d
d
28.5
d
d
28.2
% Medical Advice on Physical Activity in Past Year
Victorville
41.5
27.4
% Vigorous Physical Activity
Hesperia
22.1
43.4
34.3
d
51.8
####
#
19.4
####
#
14.2
PSA vs. SSA
d
TOTAL
AREA
PSA
SSA
##
##
36.4
54.6
53.4
###
#
58.8
d
d
d
24.0
d
45.4
d
28.8
d
34.8
d
49.9
26.9
d
46.6
d
26.2
d
35.6
d
45.0
55.4
####
####
17.0
20.6
####
####
8.3
18.8
24.3
d
44.1
d
27.3
d
33.2
d
51.1
###
#
19.1
###
#
14.1
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
d
63.2
22.9
d
22.1
50.9
h
51.3
d
42.7
23.9
41.5
d
32.9
d
34.8
d
47.8
18.8
d
19.7
14.0
d
9.9
45.7
% Child [Age 5-17] 3+ Hours per Day of Total Screen Time
B
32.6
d
35.7
44.5
##
##
17.7
##
##
13.4
d
28.7
d
43.4
Respiratory Diseases
CLRD (Age-Adjusted Death Rate)
Pneumonia/Influenza (Age-Adjusted Death Rate)
% Nasal/Hay Fever Allergies
% Sinusitis
% Chronic Lung Disease
Apple
Valley
####
#
x
####
#
x
d
% [Adult] Currently Has Asthma
% Child [Age 2-17] Asthma (Ever Diagnosed)
% [Child 2-17] Currently Has Asthma
Hesperia
Victorville
####
####
x
x
####
####
x
d
TOTAL
AREA
PSA
SSA
##
##
x
##
##
x
61.5
x
###
#
x
###
#
x
d
d
d
28.2
22.9
26.2
28.0
28.9
d
d
d
d
d
13.2
d
10.5
15.3
16.6
11.4
14.1
d
d
d
d
9.5
11.8
9.9
12.5
d
d
d
d
d
d
8.7
####
####
5.8
10.6
####
####
5.8
10.6
11.6
5.1
9.2
###
#
10.0
###
#
8.1
B
d
8.4
16.6
12.4
####
#
13.7
####
#
7.3
6.8
##
##
13.8
##
##
8.8
h
18.1
d
13.0
12.9
d
h
41.5
19.4
20.9
d
h
8.9
17.2
d
h
worse
27.3
15.9
d
h
21.3
29.3
d
similar
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
39.3
29.5
7.5
% Adults Asthma (Ever Diagnosed)
PSA vs. SSA
B
better
d
d
13.6
11.9
d
d
7.8
10.7
7.5
d
11.8
8.2
d
6.8
B
better
d
similar
h
worse
22
Sexually Transmitted Diseases
Gonorrhea Incidence per 100,000
Primary & Secondary Syphilis Incidence per 100,000
Chlamydia Incidence per 100,000
Hepatitis B Incidence per 100,000
% [Unmarried 18-64] Using Condoms
% [Age 18-64 Unmarried] 3+ Sexual Partners in Past Year
Apple
Valley
####
#
x
####
#
x
####
#
x
####
#
x
####
#
45.4
####
#
32.5
PSA vs. SSA
Hesperia
Victorville
####
####
x
x
####
####
x
x
####
####
x
x
####
####
x
x
####
####
53.7
44.4
####
####
3.6
4.9
PSA
SSA
###
#
x
###
#
x
###
#
x
###
#
x
###
#
47.9
###
#
10.1
##
##
x
##
##
x
##
##
x
##
##
x
##
##
38.7
##
##
8.7
TOTAL
AREA
57.2
1.7
Substance Abuse
Cirrhosis/Liver Disease (Age-Adjusted Death Rate)
% Current Drinker
% Chronic Drinker (Average 2+ Drinks/Day)
Apple
Valley
####
#
x
404.3
0.6
% Drinking & Driving in Past Month
Drug-Induced Deaths (Age-Adjusted Death Rate)
% Illicit Drug Use in Past Month
####
x
x
TOTAL
AREA
SSA
###
#
x
##
##
x
13.7
d
d
B
B
h
5.6
2.4
4.2
12.0
12.0
10.7
11.0
11.1
21.4
h
d
d
d
d
d
1.9
h
4.1
h
4.5
d
d
d
1.7
d
2.2
d
1.7
d
2.7
2.5
####
#
x
d
d
####
####
x
h
d
d
4.0
2.2
1.4
d
7.8
2.7
B
1.5
B
2.5
B
d
d
3.2
d
7.6
7.0
d
d
d
h
8.2
B
58.8
5.6
d
16.7
B
24.3
d
d
d
5.5
d
11.1
3.5
B
d
12.2
11.3
d
B
1.7
7.1
B
9.9
9.0
2.9
d
d
B
h
52.9
10.6
11.3
8.3
h
worse
3.5
x
d
h
3.8
12.7
##
##
x
3.1
d
similar
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
15.8
2.5
###
#
x
1.6
d
6.1
13.0
d
1.5
d
11.1
d
4.0
B
B
PSA
d
B
better
56.6
d
d
391.6
7.1
45.8
d
d
4.3
387.9
9.8
45.8
7.6
% Ever Sought Help for Alcohol or Drug Problem
####
B
37.2
46.7
d
2.5
% Driving Drunk or Riding with Drunk Driver
Victorville
B
45.9
44.6
1.0
% Rode With Drunk Driver in Past Month
Hesperia
B
109.3
0.8
47.7
7.2
% Binge Drinker (5+ Drinks Per Occasion Men, 4+ Women)
PSA vs. SSA
B
65.4
5.4
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
3.9
B
better
d
similar
h
worse
23
Tobacco Use
% Current Smoker
% Someone Smokes at Home
% [Household With Children] Someone Smokes in the Home
% [Smokers] Received Advice to Quit Smoking
% [Smokers] Have Quit Smoking 1+ Days in Past Year
% Smoke Cigars
Hesperia
Victorville
PSA
SSA
d
d
d
B
h
16.3
16.0
13.7
13.6
14.3
25.2
h
B
13.4
d
14.2
d
14.7
7.9
d
16.9
h
d
d
d
d
6.2
14.0
####
#
23.1
####
#
71.7
####
#
54.5
4.6
####
3.5
8.4
####
####
61.1
59.5
####
####
53.2
59.0
d
d
d
d
d
5.0
d
d
d
d
d
2.2
4.8
6.6
1.6
2.0
5.2
2.3
5.6
##
##
14.2
##
##
49.3
##
##
50.8
Vision
% Blindness/Trouble Seeing
Apple
Valley
Hesperia
Victorville
PSA
5.7
d
d
d
d
12.3
% Eye Exam in Past 2 Years
d
39.2
8.4
d
50.0
9.2
d
48.6
9.7
d
46.6
d
12.1
59.5
d
63.7
54.4
d
B
TOTAL
AREA
d
h
d
h
d
10.8
d
46.2
d
similar
0.2
0.3
h
worse
TOTAL AREA vs.
Benchmarks
vs.
CA
vs.
US
vs.
HP2020
h
15.4
6.9
h
44.1
80.0
2.8
better
h
56.2
4.2
1.2
SSA
h
12.0
d
3.7
PSA vs. SSA
d
16.6
d
11.7
d
13.6
####
3.9
2.5
TOTAL AREA vs.
Benchmarks
vs.
vs.
vs.
CA
US
HP2020
12.8
6.3
###
#
11.1
###
#
63.6
###
#
56.0
3.5
% Use Smokeless Tobacco
TOTAL
AREA
Apple
Valley
23.3
% [Non-Smokers] Someone Smokes in the Home
PSA vs. SSA
57.5
B
better
d
similar
h
worse
24
GENERAL
HEALTH STATUS
25
Overall Health Status
The initial inquiry of the
2011 PRC Community
Health Survey asked
respondents the following:
A total of 44.6% of Total Area adults rate their overall health as “excellent”
or “very good.”

Another 34.6% gave “good” ratings of their overall health.
“Would you say that in
general your health is:
excellent, very good, good,
fair or poor?”
(Total Area, 2011)
Poor 6.4%
Excellent 15.5%
Fair 14.4%
Very Good 29.1%
Good 34.6%
Sources:
Notes:
NOTE:
●
Differences noted in
the text represent
significant differences
determined through
statistical testing.
 Professional Research Consultants, Inc. PRC Community Health Survey. [Item 5]
 Asked of all respondents.
However, 20.8% of Total Area adults believe that their overall health is
“fair” or “poor.”
 Statistically similar to statewide findings.
 Statistically similar to national findings.
Statistically similar between the Primary and Secondary service areas.
 Where sample sizes
permit, communitylevel data are provided.
Within the Primary Service Area, more favorable in Hesperia.
Experience “Fair” or “Poor” Physical Health
100%
80%
60%
40%
24.0%
23.4%
20%
20.3%
23.2%
20.8%
19.6%
Total
Area
California
13.3%
16.8%
0%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
United
States
Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 5]
● Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human Services,
Centers for Disease Control and Prevention, 2009 California Data.
● Professional Research Consultants. PRC National Health Survey. 2011.
Notes:
● Asked of all respondents.
26
Adults more likely to report experiencing “fair” or “poor” overall health include:
 Residents aged 40 and older.
 Residents living at lower incomes.
 Non-Whites.
 Other differences within demographic groups, as illustrated in the following
chart, are not statistically significant.
Charts throughout this
report (such as that here)
detail survey findings
among key demographic
groups – namely by gender,
age groupings, income
(based on poverty status),
and race/ethnicity.
Experience “Fair” or “Poor” Physical Health
(Total Area, 2011)
100%
80%
60%
34.1%
40%
25.3%
24.9%
20%
16.9%
15.9%
Women
18 to 39
26.3%
27.5%
23.4%
13.6%
15.0%
200%+
FPL
White
20.8%
0%
Men
40 to 64
65+
<200%
FPL
Hispanic
Other
Total
Area
Notes:
● Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size.
27
An individual can get a disabling impairment or chronic condition at any point in life. Compared with
people without disabilities, people with disabilities are more likely to:
 Experience difficulties or delays in getting the health care they need.
 Not have had an annual dental visit.
 Not have had a mammogram in past 2 years.
 Not have had a Pap test within the past 3 years.
 Not engage in fitness activities.
 Use tobacco.
 Be overweight or obese.
 Have high blood pressure.
 Experience symptoms of psychological distress.
 Receive less social-emotional support.
 Have lower employment rates.
There are many social and physical factors that influence the health of people with disabilities. The
following three areas for public health action have been identified, using the International
Classification of Functioning, Disability, and Health (ICF) and the three World Health Organization
(WHO) principles of action for addressing health determinants.
 Improve the conditions of daily life by: encouraging communities to be accessible so all
can live in, move through, and interact with their environment; encouraging community living;
and removing barriers in the environment using both physical universal design concepts and
operational policy shifts.
 Address the inequitable distribution of resources among people with disabilities and
those without disabilities by increasing: appropriate health care for people with disabilities;
education and work opportunities; social participation; and access to needed technologies and
assistive supports.
 Expand the knowledge base and raise awareness about determinants of health for
people with disabilities by increasing: the inclusion of people with disabilities in public
health data collection efforts across the lifespan; the inclusion of people with disabilities in
health promotion activities; and the expansion of disability and health training opportunities
for public health and health care professionals.
–
Healthy People 2020 (www.healthypeople.gov)
A total of 24.4% of Total Area adults are limited in some way in some
activities due to a physical, mental or emotional problem.
 Less favorable than prevalence statewide.
 Less favorable than the national prevalence.
Statistically similar by service area.
Within the Primary Service Area, no statistically significant differences to
report.
28
Limited in Activities in Some Way
Due to a Physical, Mental or Emotional Problem
100%
80%
60%
40%
32.9%
22.2%
RELATED ISSUE:
See also
Potentially Disabling
Conditions in the Death,
Disease & Chronic
Conditions section of
this report.
20%
27.9%
23.7%
18.9%
24.4%
17.2%
17.0%
California
United
States
0%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
Notes:
In looking at responses by key demographic characteristics, note the following:
 Total Area men are more likely than women to report activity limitations.
 Adults age 40 and older are much more often limited in activities (note the
positive correlation with age).
 Residents of “Other” races are more likely than Whites and Hispanics to
report activity limitations.
Limited in Activities in Some Way
Due to a Physical, Mental or Emotional Problem
(Total Area, 2011)
100%
80%
60%
46.6%
37.9%
40%
31.3%
29.2%
29.6%
22.3%
20.0%
26.1%
14.3%
20%
24.4%
13.3%
0%
Men
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
Notes:
29
Among persons reporting activity limitations, these are most often attributed to
musculoskeletal issues, such as back/neck problems, difficulty walking, arthritis/
rheumatism, or fractures or bone/joint injuries.
Type of Problem That Limits Activities
(Among Those Reporting Activity Limitations; Total Area, 2011)
0%
20%
Back/Neck Problem
Heart Problem
Various Other (<3% Each)
Sources:
Notes:
100%
10.0%
Fracture/Bone/Joint Injury
Eye/Vision Problem
80%
13.4%
Arthritis/Rheumatism
Lung/Breathing Problem
60%
16.9%
Walking Problem
Depression/Anxiety/Mental
40%
9.2%
8.2%
5.4%
3.9%
3.2%
29.8%
 Asked of those respondents reporting activity limitations.
30
Mental Health & Mental Disorders
Mental health is a state of successful performance of mental function, resulting in productive
activities, fulfilling relationships with other people, and the ability to adapt to change and to cope
with challenges. Mental health is essential to personal well-being, family and interpersonal
relationships, and the ability to contribute to community or society. Mental disorders are health
conditions that are characterized by alterations in thinking, mood, and/or behavior that are associated
with distress and/or impaired functioning. Mental disorders contribute to a host of problems that may
include disability, pain, or death. Mental illness is the term that refers collectively to all diagnosable
mental disorders.
Mental disorders are among the most common causes of disability. The resulting disease burden of
mental illness is among the highest of all diseases. According to the national Institute of Mental
Health (NIMH), in any given year, an estimated 13 million American adults (approximately 1 in 17)
have a seriously debilitating mental illness. Mental health disorders are the leading cause of disability
in the United States and Canada, accounting for 25% of all years of life lost to disability and
premature mortality. Moreover, suicide is the 11th leading cause of death in the United States,
accounting for the deaths of approximately 30,000 Americans each year.
Mental health and physical health are closely connected. Mental health plays a major role in people's
ability to maintain good physical health. Mental illnesses, such as depression and anxiety, affect
people's ability to participate in health-promoting behaviors. In turn, problems with physical health,
such as chronic diseases, can have a serious impact on mental health and decrease a person's ability to
participate in treatment and recovery.
The existing model for understanding mental health and mental disorders emphasizes the interaction
of social, environmental, and genetic factors throughout the lifespan. In behavioral health,
researchers identify: risk factors, which predispose individuals to mental illness; and protective
factors, which protect them from developing mental disorders. Researchers now know that the
prevention of mental, emotional, and behavioral (MEB) disorders is inherently interdisciplinary and
draws on a variety of different strategies. Over the past 20 years, research on the prevention of
mental disorders has progressed. The understanding of how the brain functions under normal
conditions and in response to stressors, combined with knowledge of how the brain develops over
time, has been essential to that progress. The major areas of progress include evidence that:
 MEB disorders are common and begin early in life.
 The greatest opportunity for prevention is among young people.
 There are multiyear effects of multiple preventive interventions on reducing substance abuse,
conduct disorder, antisocial behavior, aggression, and child maltreatment.
 The incidence of depression among pregnant women and adolescents can be reduced.
 School-based violence prevention can reduce the base rate of aggressive problems in an
average school by 25 to 33%.
 There are potential indicated preventive interventions for schizophrenia.
 Improving family functioning and positive parenting can have positive outcomes on mental
health and can reduce poverty-related risk.
 School-based preventive interventions aimed at improving social and emotional outcomes can
also improve academic outcomes.
 Interventions targeting families dealing with adversities, such as parental depression or divorce,
can be effective in reducing risk for depression among children and increasing effective
parenting.
 Some preventive interventions have benefits that exceed costs, with the available evidence
strongest for early childhood interventions.
 Implementation is complex, and it is important that interventions be relevant to the target
audiences.
In addition to advancements in the prevention of mental disorders, there continues to be steady
progress in treating mental disorders as new drugs and stronger evidence-based outcomes become
available.
–
31
“Now thinking about
your mental health,
which includes stress,
depression and problems
with emotions, would you
say that, in general, your
mental health is:
excellent, very good,
good, fair or poor?”
Mental Health Status
Self-Reported Mental Health Status
Most Total Area adults (58.7%) rate their overall mental health as
“excellent” or “very good.”

Another 27.5% gave “good” ratings of their own mental health status.
Self-Reported Mental Health Status
(Total Area, 2011)
Poor 5.0%
Fair 8.9%
Excellent 29.6%
Good 27.5%
Very Good 29.1%
Sources:
Notes:
A total of 13.9% of Total Area adults, however, believe that their overall
mental health is “fair” or “poor.”
 Similar to the “fair/poor” response reported nationally.
Significantly lower (more favorable) in the Primary Service Area than in the
Secondary Service Area.
Within the Primary Service Area, most favorable in Hesperia.
Experience “Fair” or “Poor” Mental Health
100%
80%
60%
40%
25.9%
20%
11.5%
8.0%
13.4%
11.1%
Victorville
(PSA)
PSA
Overall
13.9%
11.7%
Total
Area
United
States
0%
Apple Valley
(PSA)
Hesperia
(PSA)
SSA
Overall
● Professional Research Consultants, Inc. PRC National Health Survey. 2011.
Notes:
32
 Note the negative correlation between poor mental health and income.
 Adults of “Other” races are much more likely to report experiencing
“fair/poor” mental health than Whites or Hispanics.
Experience “Fair” or “Poor” Mental Health
(Total Area, 2011)
100%
80%
60%
40%
20%
15.1%
12.6%
16.4%
24.7%
19.5%
13.3%
8.2%
8.1%
12.1%
11.8%
White
Hispanic
13.9%
0%
Men
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
Other
Total
Area
Notes:
Depression
Major Depression
A total of 11.5% of Total Area adults have been diagnosed with major
depression by a physician or other healthcare professional.
 Nearly identical to the national finding.
Similar when viewed by service area.
Within the Primary Service Area, no significant differences.
Have Been Diagnosed With Major Depression
100%
80%
60%
40%
20%
8.5%
17.0%
11.1%
10.5%
10.2%
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
11.5%
11.7%
Total
Area
United
States
0%
Apple Valley
(PSA)
SSA
Overall
Notes:
33
 Viewed by demographic characteristic, it is higher among adults age 40 to
64.
Have Been Diagnosed With Major Depression
(Total Area, 2011)
100%
80%
60%
40%
20%
14.2%
8.9%
9.6%
Women
18 to 39
20.0%
14.8%
8.8%
11.8%
8.4%
10.4%
8.6%
200%+
FPL
White
Hispanic
11.5%
0%
Men
40 to 64
65+
<200%
FPL
Other
Total
Area
Notes:
Symptoms of Chronic Depression
A total of 30.6% of Total Area adults have had two or more years in their
lives when they felt depressed or sad on most days, although they may
have felt okay sometimes (chronic depression).
 Similar to national findings.
Similar by service area.
Within the Primary Service Area, the findings are statistically similar.
Have Experienced Symptoms of Chronic Depression
100%
80%
60%
40%
30.6%
32.0%
Hesperia
(PSA)
Victorville
(PSA)
23.6%
35.9%
29.4%
30.6%
26.5%
20%
0%
Apple Valley
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
Notes:
34
 Note that the prevalence of chronic depression is notably higher among
adults age 40 to 64, as well as those living below the 200% poverty
threshold.
Have Experienced Symptoms of Chronic Depression
(Total Area, 2011)
100%
80%
60%
40%
33.6%
27.3%
38.4%
35.8%
28.3%
25.9%
23.4%
30.8%
27.9%
35.0%
30.6%
20%
0%
Men
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
Notes:
Stress
RELATED ISSUE:
See also Substance Abuse
in the Modifiable
Health Risks section
of this report.
More than 4 in 10 Total Area adults consider their typical day to be “not
very stressful” (27.4%) or “not at all stressful” (16.2%).
 Another 46.0% of survey respondents characterize their typical day as
“moderately stressful.”
Perceived Level of Stress On a Typical Day
(Total Area, 2011)
Not At All Stressful
16.2%
Not Very Stressful
27.4%
Sources:
Notes:
Extremely Stressful
2.4%
Very Stressful 7.9%
Moderately Stressful
46.0%
35
In contrast, 10.3% of Total Area adults experience “very” or “extremely”
stressful days on a regular basis.
 Comparable to national findings.
Comparable by service area.
Within the Primary Service Area, more favorable in Hesperia.
Perceive Most Days As “Extremely” or “Very” Stressful
100%
80%
60%
40%
20%
13.6%
5.2%
10.3%
9.5%
Victorville
(PSA)
PSA
Overall
14.2%
10.3%
11.5%
Total
Area
United
States
0%
Apple Valley
(PSA)
Hesperia
(PSA)
SSA
Overall
Notes:
 Note that high stress levels are more prevalent among young adults (those
under age 40).
Perceive Most Days as “Extremely” or “Very” Stressful
(Total Area, 2011)
100%
80%
60%
40%
20%
10.2%
10.5%
Men
Women
12.9%
10.3%
13.6%
4.8%
7.8%
17.6%
10.3%
10.3%
7.0%
0%
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
Notes:
36
Suicide
Between 2005 and 2007, there was an annual average age-adjusted suicide
rate of 9.7 deaths per 100,000 population across San Bernadino County.
 Similar to the statewide rate.
 Lower than the national rate.
 Satisfies the Healthy People 2020 target of 10.2 or lower.
Suicide: Age-Adjusted Mortality
(2005-2007 Annual Average Deaths per 100,000 Population)
50
Healthy People 2020 Target = 10.2 or Lower
40
30
20
11.1
9.7
9.4
San Bernardino County
California
10
0
United States
Sources: ● Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. CDC WONDER Online Query System.
Data extracted May 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective MHMD-1]
Notes:
● Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
● Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population.
● County, state and national data are simple three-year averages.
 Suicide rates across the county appear notably higher among Non-Hispanic
Whites than among Hispanics and Non-Hispanic “Other” races.
Suicide: Age-Adjusted Mortality by Race
50
40
30
20
14.4
9.7
10
5.1
6.1
Hispanic
Non-Hispanic Other
0
Non-Hispanic White
San Bernadino County
All Races/Ethnicities
Notes:
37
 San Bernadino County suicide rates have overall trended downward. In
contrast, suicide is on the increase nationwide.
Suicide: Age-Adjusted Mortality Trends
(Annual Average Deaths per 100,000 Population)
50
40
30
20
10
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
Healthy People 2020
10.2
10.2
10.2
10.2
10.2
10.2
10.2
San Bernardino Co.
10.6
10.3
10.4
10.9
10.7
10.3
9.7
California
9.1
9.1
9.3
9.7
9.5
9.3
9.4
United States
10.5
10.7
10.8
10.9
10.9
11.0
11.1
Data extracted March 2011.
Notes:
● State and national data are simple three-year averages.
Mental Health Treatment
Among adults with diagnosed depression, 76.3% acknowledge that they
have sought professional help for a mental or emotional problem.
“Diagnosed depression”
includes respondents
reporting a past diagnosis
of major depression by a
physician.
 Similar to the Healthy People 2020 goal of 75.1% or higher.
Have Sought Professional Help
for a Mental or Emotional Problem
(Among Those With Major Depression; Total Area, 2011)
100%
Healthy People 2020 Target = 75.1% or Higher
80%
76.3%
82.0%
60%
40%
20%
0%
Total Area Adults w/Major Depression
Sources: ●
●
●
Notes:
●
●
United States Adults w/Major Depression
Professional Research Consultants, Inc. PRC Community Health Survey. [Item 147]
Professional Research Consultants. PRC National Health Survey. 2011.
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective MHMD-9.1]
Asked of those respondents with major depression.
Trend data represent those adults with “recognized depression,” including those who have been diagnosed with major depression OR have experienced 2+ years of
depression at some point in their lives.
38
Children & ADD/ADHD
Among Total Area adults with children age 5 to 17, 2.2% report that their
child takes medication for ADD/ADHD.
 More favorable than the prevalence reported across the US.
Child Takes Medication for ADD/ADHD
(Among Total Area Parents of Children Aged 5-17, 2011)
Yes
2.2%
No
93.5%
No
97.8%
Total Area
Sources:
Notes:
Yes
6.5%
United States
 Professional Research Consultants, Inc. PRC National Health Survey. 2011.
 Asked of all respondents with children aged 5 to 17.
39
DEATH, DISEASE &
CHRONIC CONDITIONS
40
Leading Causes of Death
Distribution of Deaths by Cause
Together, heart disease, stroke, and cancers accounted for nearly one-half
of all deaths in San Bernadino County in 2007.
(San Bernardino County, 2007)
Other 26.0%
Unintentional Injuries
3.5%
Alzheimer's Disease
3.9%
Diabetes Mellitus
4.3%
Heart Disease 27.0%
Stroke 7.0%
CLRD 7.1%
Cancer 21.2%
Notes:
● CLRD is chronic lower respiratory disease.
In order to compare mortality in the region with other localities (in this case,
California and the United States), it is necessary to look at rates of death — these
are figures which represent the number of deaths in relation to the population size
(such as deaths per 100,000 population, as is used here).
Furthermore, in order to compare localities without undue bias toward younger or
older populations, the common convention is to adjust the data to some common
baseline age distribution. Use of these “age-adjusted” rates provides the most
valuable means of gauging mortality against benchmark data, as well as Healthy
People 2020 targets.
The following chart outlines 2005-2007 annual average age-adjusted death rates per
100,000 population for selected causes of death across San Bernadino County.
41
For infant mortality data,
see “Birth Outcomes &
Risks” in the Births
section of this report.
Age-adjusted mortality rates across the county are worse than national
rates for most of the causes illustrated below (the exceptions being cancer,
kidney disease, HIV, suicide and unintentional injuries).
Of the causes outlined in the following chart for which Healthy People 2020
objectives have been established, San Bernadino County rates fail to satisfy the goals
set for each cause of death, with the exception of suicide and unintentional injuries.
(2005-2007 Deaths per 100,000)
California
US
HP2020
Diseases of the Heart
252.6
189.9
200.9
152.7*
Malignant Neoplasms (Cancers)
184.3
164.2
181.0
160.6
Chronic Lower Respiratory Disease (CLRD)
61.5
39.3
41.5
n/a
Cerebrovascular Disease (Stroke)
49.5
45.1
44.2
33.8
Unintentional Injuries
32.0
31.8
39.7
36.0
Diabetes Mellitus
32.0
22.5
23.5
19.6*
Alzheimers Disease
28.4
24.0
22.7
n/a
Pneumonia/Influenza
22.9
21.3
18.1
n/a
Motor Vehicle Crashes
16.7
11.7
14.3
12.4
Cirrhosis/Liver Disease
13.7
11.1
9.0
8.2
Kidney Disease
11.7
8.0
14.5
n/a
Drug-Induced
11.3
11.1
12.2
11.3
Firearm-Related
11.2
9.2
10.3
9.2
Intentional Self-Harm (Suicide)
9.7
9.4
11.1
10.2
Homicide/Legal Intervention
8.7
6.7
6.1
5.5
HIV/AIDS **
3.4
4
4.6
3.3
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov.
Note:
● Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population and coded using ICD-10 codes.
● *The Healthy People 2020 Heart Disease target is adjusted to account for all diseases of the heart; the Diabetes target is adjusted to reflect only diabetes mellitus-coded deaths.
● County, state and national data are simple three-year averages. **HIV/AIDS data is 1999-2007.
42
Cardiovascular Disease
Heart disease is the leading cause of death in the United States, with stroke following as the third
leading cause. Together, heart disease and stroke are among the most widespread and costly health
problems facing the nation today, accounting for more than $500 billion in healthcare expenditures
and related expenses in 2010 alone. Fortunately, they are also among the most preventable.
The leading modifiable (controllable) risk factors for heart disease and stroke are:
 High blood pressure
 High cholesterol
 Cigarette smoking
 Diabetes
 Poor diet and physical inactivity
 Overweight and obesity
The risk of Americans developing and dying from cardiovascular disease would be substantially
reduced if major improvements were made across the US population in diet and physical activity,
control of high blood pressure and cholesterol, smoking cessation, and appropriate aspirin use.
The burden of cardiovascular disease is disproportionately distributed across the population. There are
significant disparities in the following based on gender, age, race/ethnicity, geographic area, and
socioeconomic status:
 Prevalence of risk factors
 Access to treatment
 Appropriate and timely treatment
 Treatment outcomes
 Mortality
Disease does not occur in isolation, and cardiovascular disease is no exception. Cardiovascular health is
significantly influenced by the physical, social, and political environment, including: maternal and
child health; access to educational opportunities; availability of healthy foods, physical education, and
extracurricular activities in schools; opportunities for physical activity, including access to safe and
walkable communities; access to healthy foods; quality of working conditions and worksite health;
availability of community support and resources; and access to affordable, quality healthcare.
–
Age-Adjusted Heart Disease & Stroke Deaths
The greatest share
of cardiovascular
deaths is attributed
to heart disease.
Heart Disease Deaths
Between 2005 and 2007, there was an annual average age-adjusted heart
disease mortality rate of 252.6 deaths per 100,000 population across San
Bernadino County.
 Less favorable than the statewide rate.
 Less favorable than the national rate.
 Fails to satisfy the Healthy People 2020 objective (as adjusted to account for
all diseases of the heart).
43
Heart Disease: Age-Adjusted Mortality
600
Healthy People 2020 Target = 152.7 or Lower (Adjusted)
500
400
300
252.6
189.9
200.9
California
United States
200
100
0
Data extracted March 2011.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective HDS-2]
Notes:
● The Healthy People 2020 Heart Disease target is adjusted to account for all diseases of the heart.
 By race, heart disease mortality rates are notably higher among Whites.
Heart Disease: Age-Adjusted Mortality by Race
600
500
400
300
284.4
241.5
252.6
Non-Hispanic Other
169.9
200
100
0
Non-Hispanic White
Hispanic
Notes:
44
 Heart disease mortality rates have decreased throughout San Bernadino
County, echoing the decreasing trends across California and the US overall.
Heart Disease: Age-Adjusted Mortality Trends
600
500
400
300
200
100
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
Healthy People 2020
152.7
152.7
152.7
152.7
152.7
152.7
152.7
San Bernardino Co.
299.3
289.6
286.6
279.2
271.2
262.7
252.6
California
242.9
232.9
226.6
217.7
208.2
198.8
189.9
United States
257.3
249.0
240.4
230.3
220.4
209.7
200.9
Notes:
Stroke Deaths
Between 2005 and 2007, there was an annual average age-adjusted stroke
mortality rate of 49.5 deaths per 100,000 population in San Bernadino
County.
 Less favorable than the California rate.
 Fails to satisfy the Healthy People 2020 target of 33.8 or lower.
Stroke: Age-Adjusted Mortality
100
80
60
49.5
45.1
44.2
California
United States
40
20
0
Notes:
45
 The county's stroke mortality is higher among “Other” races when compared
with Whites and Hispanics.
Stroke: Age-Adjusted Mortality by Race
100
80
56.2
60
49.5
49.5
43.3
40
20
0
Non-Hispanic White
Hispanic
Non-Hispanic Other
Notes:
 San Bernadino County stroke rates have declined considerably in recent
years, echoing the trends reported across California and the US overall.
Stroke: Age-Adjusted Mortality Trends
100
80
60
40
20
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
Healthy People 2020
33.8
33.8
33.8
33.8
33.8
33.8
33.8
San Bernardino Co.
64.0
61.9
61.2
58.4
55.2
51.1
49.5
California
63.3
61.3
59.0
56.3
52.8
48.8
45.1
United States
60.1
58.4
55.9
53.3
50.1
46.8
44.2
Notes:
46
Prevalence of Heart Disease & Stroke
Prevalence of Heart Disease
A total of 5.7% of surveyed adults report that they suffer from or have
been diagnosed with heart disease, such as coronary heart disease, angina
or heart attack.
 Similar to the national prevalence.
Note that 4.9% of adults
have had a heart attack
(myocardial infarction) and
3.5% have been diagnosed
with angina/coronary
heart disease.
In all, 5.7% report
one or the other.
No significant differences within the Primary Service Area.
100%
80%
60%
40%
20%
7.2%
4.5%
6.0%
5.8%
4.9%
5.7%
6.1%
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
0%
Apple Valley
(PSA)
Notes:
Adults more likely to have been diagnosed with chronic heart disease include:
 Residents aged 40 and older (especially males).
 Those with lower incomes.
(Total Area, 2011)
100%
80%
60%
Men 65+: 13.1%
Women 65+: 6.8%
40%
20%
7.6%
3.8%
2.5%
Women
18 to 39
7.9%
10.3%
8.7%
2.3%
5.4%
4.0%
White
Hispanic
8.6%
5.7%
0%
Men
40 to 64
65+
<200%
FPL
200%+
FPL
Other
Total
Area
Notes:
47
Prevalence of Stroke
A total of 3.8% of surveyed adults report that they suffer from or have
been diagnosed with cerebrovascular disease (a stroke).
 Similar to statewide findings.
Within the Primary Service Area, no significant differences to report.
 Note: Among residents age 65 and older, 11.0% have had a stroke.
Prevalence of Stroke
100%
80%
60%
40%
Among 65+:11.0%
20%
4.2%
2.3%
Apple Valley
(PSA)
Hesperia
(PSA)
5.3%
4.0%
2.6%
3.8%
2.3%
2.7%
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
California
United
States
0%
Notes:
Stroke Symptom Awareness
Survey respondents were next asked to consider a series of symptoms and indicate
whether they believe the symptoms to be possible signs of a stroke.
In all, only 11.5% of respondents were able to answer all of the stroke
symptom awareness questions, and answer them correctly.
 Specifically, 8 in 10 respondents agree that sudden numbness or
weakness of the face, arm, or leg should be considered a sign of stroke,
followed by sudden trouble walking or dizziness (mentioned by 78.4%)
and sudden confusion or trouble speaking (76.3%).
 Fewer adults (62.7%) consider sudden trouble seeing to be a sign of
stroke.
 A total of 56.7% of survey respondents agree that a severe headache with
no apparent cause is a sign of potential stroke.
 A total of 48.9% consider sudden chest pain or discomfort to be a sign of
stroke (it is not).
48
Considered as Stroke Symptoms
(Total Area, 2011)
0%
20%
40%
60%
80%
Sudden Numbness/Weakness
of Face, Arm, or Leg
80.0%
Sudden Trouble Walking or
Dizziness
78.4%
Sudden Confusion/Trouble
Speaking
76.3%
Sudden Trouble Seeing
62.7%
Severe Headache w/No
Apparent Cause
In all, only 11.5% of
respondents were
able to answer all of
the stroke symptom
awareness questions,
and answer them
correctly.
56.7%
Sudden Chest Pain or
Discomfort
Sources:
Notes:
100%
48.9%
 Professional Research Consultants, Inc. PRC Community Health Survey. [Items 41-46]
In a related inquiry, survey respondents were asked to report what they would do if
someone near them were having heart attack or stroke symptoms.
The vast majority of Total Area adults (86.9%) would call 911 if someone
near them appeared to be having a heart attack or a stroke.
 Another 4.9% would drive the person to a hospital, and less than one
percent (0.9%) would first urge the person to call their own physician.
First Action Taken if Someone Nearby
Were Having Heart Attack or Stroke Symptoms
(Total Area, 2011)
Call 911 86.9%
Other 7.3%
Take Them to
Hospital 4.9%
Call Dr 0.9%
Sources:
Notes:
49
Cardiovascular Risk Factors
Hypertension (High Blood Pressure)
Controlling risk factors for heart disease and stroke remains a challenge. High blood pressure and
cholesterol are still major contributors to the national epidemic of cardiovascular disease. High blood
pressure affects approximately 1 in 3 adults in the United States, and more than half of Americans
with high blood pressure do not have it under control. High sodium intake is a known risk factor for
high blood pressure and heart disease, yet about 90% of American adults exceed their
recommendation for sodium intake.
–
High Blood Pressure Testing
A total of 95.3% of Total Area adults have had their blood pressure tested
within the past two years.
 Similar to the Healthy People 2020 target (94.9% or higher).
Have Had Blood Pressure Checked in the Past 2 Years
100%
95.7%
97.7%
94.5%
95.8%
92.8%
95.3%
94.7%
SSA
Overall
Total
Area
United
States
80%
60%
????
40%
20%
0%
Apple Valley
(PSA)
Sources: ●
●
●
Notes:
●
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective HDS-4]
Asked of all respondents.
Prevalence of Hypertension
A total of 37.1% of adults have been told at some point that their blood
pressure was high.
 Less favorable than the California prevalence.
 Fails to satisfy the Healthy People 2020 target (26.9% or lower).
Similar between the two service areas.
No significant differences among the communities of Apple Valley, Hesperia,
and Victorville.
 Among hypertensive adults, 77.6% have been diagnosed with high blood
pressure more than once.
50
Prevalence of High Blood Pressure
100%
Healthy People 2020 Target = 26.9% or Lower
Number of Times Diagnosed:
Once = 22.4%
More Than Once = 77.6%
80%
60%
42.2%
35.4%
40%
37.6%
36.5%
34.7%
37.1%
34.3%
25.7%
20%
0%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
California
United
States
Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Items 53-54, 149]
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective HDS-5.1]
Notes:
Note that just 1.4% of Total Area adults have not had their blood pressure tested in
the past 5 years, if ever. For these individuals, prevalence is unknown.
Hypertension diagnoses are higher among:
 Men.
 Adults age 40 and older, and especially those age 65+.
 Non-Hispanics.
Prevalence of High Blood Pressure
(Total Area, 2011)
100%
80%
71.1%
60%
40%
49.2%
44.1%
43.0%
40.0%
42.2%
37.1%
32.4%
31.4%
26.2%
19.4%
20%
0%
Men
Sources: ●
●
Notes:
●
●
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective HDS-5.1]
Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size.
51
Hypertension Management
Respondents reporting
high blood pressure
were further asked:
“Are you currently
taking any action to
help control your high
blood pressure, such as
taking medication,
changing your diet, or
exercising?”
Among respondents who have been told that their blood pressure was
high, 89.9% report that they are currently taking actions to control their
condition.
 Nearly identical to national findings.
Taking Action to Control Hypertension
(Among Total Area Adults with High BP, 2010)
100%
89.9%
89.1%
Total Area
United States
80%
60%
40%
20%
0%
Sources: ●
●
●
●
Notes:
Asked of all respondents who have been diagnosed with high blood pressure.
In this case, the term “action” refers to medication, change in diet, and/or exercise.
High Blood Cholesterol
Blood Cholesterol Testing
A total of 90.1% of Total Area adults have had their blood cholesterol
checked within the past five years.
 More favorable than California findings.
 Nearly identical to the national findings.
 Satisfies the Healthy People 2020 target (82.1% or higher).
Have Had Blood Cholesterol Levels Checked in the Past 5 Years
100%
89.6%
89.4%
90.5%
90.0%
90.5%
90.7%
90.1%
74.5%
80%
60%
40%
20%
0%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
California
United
States
Notes:
52
The following demographic segments report lower screening levels:
 Young adults.
 Hispanics.
Have Had Blood Cholesterol Levels Checked in the Past 5 Years
(Total Area, 2011)
100%
80%
89.0%
91.0%
Men
Women
93.3%
97.9%
83.4%
88.8%
87.6%
<200%
FPL
200%+
FPL
96.9%
91.9%
90.1%
84.8%
60%
40%
20%
0%
Sources: ●
●
Notes:
●
●
18 to 39
40 to 64
65+
White
Hispanic
Other
Total
Area
Self-Reported High Blood Cholesterol
A total of 30.4% of adults have been told by a health professional that
their cholesterol level was high.
 More favorable than the California findings.
 More than twice the Healthy People 2020 target (13.5% or lower).
Prevalence of High Blood Cholesterol
100%
80%
60%
40%
31.6%
36.5%
27.0%
29.1%
29.0%
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
30.4%
36.5%
31.4%
20%
0%
Apple Valley
(PSA)
SSA
Overall
Total
Area
California*
United
States
Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Items 150]
Notes:
● *The California data reflects those adults who have been tested for high cholesterol and who have been diagnosed with it.
53
Note that 17.5% of Total Area adults have not had their blood cholesterol checked
in the past 5 years, if ever. For these individuals, prevalence is unknown.
 Note the higher prevalence among adults age 40 and older.
 Hispanics report a notable lower prevalence.
 Keep in mind that “unknowns” are relatively high in young adults and
Hispanics.
Prevalence of High Blood Cholesterol
(Total Area, 2011)
100%
80%
60%
53.1%
41.0%
40%
32.9%
31.0%
28.0%
20%
30.1%
34.3%
33.3%
30.4%
24.1%
14.1%
0%
Men
Sources: ●
●
●
●
Notes:
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
High Cholesterol Management
Respondents reporting
high cholesterol were
further asked:
“Are you currently
taking any action to
help control your high
cholesterol, such as
taking medication,
changing your diet, or
exercising?”
Among adults who have been told that their blood cholesterol was high,
88.4% report that they are currently taking actions to control their
cholesterol levels.
 Similar to that found nationwide.
Taking Action to Control High Blood Cholesterol Levels
(Among Total Area Adults with High Cholesterol, 2010)
100%
88.4%
89.1%
Total Area
United States
80%
60%
40%
20%
0%
Sources: ●
●
Notes:
●
●
Asked of all respondents who have been diagnosed with high blood cholesterol levels.
In this case, the term “action” refers to medication, change in diet, and/or exercise.
54
Total Cardiovascular Risk
Individual level risk factors which put people at increased risk for cardiovascular diseases include:
 High Blood Pressure
 High Blood Cholesterol
 Tobacco Use
 Physical Inactivity
 Poor Nutrition
 Overweight/Obesity
 Diabetes
–
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
Three health-related behaviors contribute markedly to cardiovascular disease:
Poor nutrition. People who are overweight have a higher risk for cardiovascular disease. Almost 60%
of adults are overweight or obese. To maintain a proper body weight, experts recommend a wellbalanced diet which is low in fat and high in fiber, accompanied by regular exercise.
Lack of physical activity. People who are not physically active have twice the risk for heart disease
of those who are active. More than half of adults do not achieve recommended levels of physical
activity.
Tobacco use. Smokers have twice the risk for heart attack of nonsmokers. Nearly one-fifth of all
deaths from cardiovascular disease, or about 190,000 deaths a year nationally, are smoking-related.
Every day, more than 3,000 young people become daily smokers in the US
Modifying these behaviors is critical both for preventing and for controlling cardiovascular disease.
Other steps that adults who have cardiovascular disease should take to reduce their risk of death and
disability include adhering to treatment for high blood pressure and cholesterol, using aspirin as
appropriate, and learning the symptoms of heart attack and stroke.
– National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
A total of 82.7% of Total Area adults report one or more cardiovascular risk
factors, such as being overweight, smoking cigarettes, being physically
inactive, or having high blood pressure or cholesterol.
RELATED ISSUE:
See also
Nutrition & Overweight,
Physical Activity & Fitness
and Tobacco Use in the
Modifiable Health Risk
Within the Primary Service Area, comparable by community.
Present One or More Cardiovascular Risks or Behaviors
100%
80%
77.4%
83.5%
83.0%
81.7%
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
87.1%
82.7%
86.3%
60%
40%
20%
0%
Apple Valley
(PSA)
Sources: ●
●
Notes:
●
Notes:
●
SSA
Overall
Total
Area
United
States
Cardiovascular risk is defined as having no leisure-time physical activity OR regular/occasional smoking OR hypertension OR high blood cholesterol OR being overweight/obese.
55
Adults more likely to exhibit cardiovascular risk factors include:
 Men.
 Adults age 40 and older.
Present One or More Cardiovascular Risks or Behaviors
(Total Area, 2011)
100%
90.2%
89.2%
80%
76.4%
74.6%
Women
18 to 39
90.9%
83.6%
85.8%
<200%
FPL
200%+
FPL
85.2%
81.3%
78.4%
82.7%
60%
40%
20%
0%
Men
40 to 64
65+
White
Hispanic
Other
Total
Area
Notes:
Notes:
● Cardiovascular risk is defined as having no leisure-time physical activity OR regular/occasional smoking OR hypertension OR high blood cholesterol OR being overweight/obese.
56
Cancer
Continued advances in cancer research, detection, and treatment have resulted in a decline in both
incidence and death rates for all cancers. Among people who develop cancer, more than half will be
alive in five years. Yet, cancer remains a leading cause of death in the United States, second only to
heart disease.
Many cancers are preventable by reducing risk factors such as: use of tobacco products; physical
inactivity and poor nutrition; obesity; and ultraviolet light exposure. Other cancers can be prevented
by getting vaccinated against human papillomavirus and hepatitis B virus. In the past decade,
overweight and obesity have emerged as new risk factors for developing certain cancers, including
colorectal, breast, uterine corpus (endometrial), and kidney cancers. The impact of the current weight
trends on cancer incidence will not be fully known for several decades. Continued focus on preventing
weight gain will lead to lower rates of cancer and many chronic diseases.
Screening is effective in identifying some types of cancers (see US Preventive Services Task Force
[USPSTF] recommendations), including:
 Breast cancer (using mammography)
 Cervical cancer (using Pap tests)
 Colorectal cancer (using fecal occult blood testing, sigmoidoscopy, or colonoscopy)
–
Age-Adjusted Cancer Deaths
All Cancer Deaths
Between 2005 and 2007, there was an annual average age-adjusted cancer
County.
 Similar to the national rate.
Cancer: Age-Adjusted Mortality
400
300
200
184.3
164.2
181.0
100
0
California
United States
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective C-1]
Notes:
57
 Cancer mortality rates are notably lower among non-Hispanic Whites in San
Bernadino County.
Cancer: Age-Adjusted Mortality by Race
400
300
209.9
177.7
184.3
Non-Hispanic Other
200
128.5
100
0
Non-Hispanic White
Hispanic
Notes:
 Cancer mortality rates have decreased over the past decade across the
county; the same trend is apparent both statewide and nationwide.
Cancer: Age-Adjusted Mortality Trends
400
300
200
100
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
Healthy People 2020
160.6
160.6
160.6
160.6
160.6
160.6
160.6
199.1
199.0
196.4
190.6
188.7
186.5
184.3
California
182.2
179.5
176.5
172.6
169.8
166.3
164.2
United States
198.9
196.5
193.3
189.9
186.7
183.6
181.0
Notes:
58
Cancer Deaths by Site
Lung cancer is by far the leading cause of cancer deaths in the county
(2005-2007 data).
Other leading sites include prostate cancer among men, breast cancer
among women, and colorectal cancer (both genders).
As can be seen in the following chart (referencing 2005-2007 annual average ageadjusted death rates):
 The San Bernadino County lung cancer death rate is less favorable than the
state rate but more favorable than the national rate.
 The county's prostate cancer death rate is less favorable than both the
state and national rates.
 The county's female breast cancer death rate is less favorable than both
the state and US rates.
 San Bernadino County's colorectal cancer death rate is less favorable than
the state rate but similar to the national rate.
Note that only the county lung cancer death rate is at least comparable to the
related Healthy People 2020 objective.
Age-Adjusted Cancer Death Rates by Site
(2005-2007)
San Bernadino Co.
California
US
HP2020
Lung Cancer
46.0
40.4
51.6
45.5
Prostate Cancer
31.0
23.0
23.9
21.2
Female Breast Cancer
26.7
22.4
23.5
20.6
Colorectal Cancer
17.5
15.5
17.2
14.5
Sources: „ Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. CDC WONDER Online Query System.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov.
59
Prevalence of Cancer
Skin Cancer
A total of 7.2% of surveyed Total Area adults report having been diagnosed
with skin cancer.
 Similar to the national average.
Prevalence of Skin Cancer
100%
80%
60%
40%
20%
8.5%
5.9%
7.7%
7.3%
6.7%
7.2%
8.1%
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
0%
Apple Valley
(PSA)
Notes:
Other Cancer
A total of 4.1% of respondents have been diagnosed with some type of
(non-skin) cancer.
Within the Primary Service Area, similar by community.
Prevalence of Cancer (Other Than Skin Cancer)
100%
80%
60%
40%
20%
7.0%
1.5%
4.9%
4.3%
3.0%
4.1%
5.5%
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
0%
Apple Valley
(PSA)
Hesperia
(PSA)
Notes:
60
Cancer Risk
RELATED ISSUE:
See also
Nutrition &
Overweight, Physical
Activity & Fitness and
Tobacco Use in the
Modifiable Health
Risk section of this
report.
Reducing the nation's cancer burden requires reducing the prevalence of behavioral and
environmental factors that increase cancer risk.
 All cancers caused by cigarette smoking could be prevented. At least one-third of cancer deaths
that occur in the United States are due to cigarette smoking.
 According to the American Cancer Society, about one-third of cancer deaths that occur in the
United States each year are due to nutrition and physical activity factors, including obesity.
– National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
Cancer Screenings
The American Cancer Society recommends that both men and women get a cancerrelated checkup during a regular doctor's checkup. It should include examination for
cancers of the thyroid, testicles, ovaries, lymph nodes, oral cavity, and skin, as well as
health counseling about tobacco, sun exposure, diet and nutrition, risk factors,
sexual practices, and environmental and occupational exposures.
Screening levels in the community were measured in the 2011 Community Health
Survey relative to four cancer sites: prostate cancer (prostate-specific antigen testing
and digital rectal examination); female breast cancer (mammography); cervical
cancer (Pap smear testing); and colorectal cancer (sigmoidoscopy and fecal occult
blood testing).
61
Prostate Cancer Screenings
The US Preventive Services Task Force (USPSTF) concludes that the current evidence is
insufficient to assess the balance of benefits and harms of prostate cancer screening in
men younger than age 75 years.
Rationale: Prostate cancer is the most common nonskin cancer and the second-leading cause of
cancer death in men in the United States. The USPSTF found convincing evidence that prostatespecific antigen (PSA) screening can detect some cases of prostate cancer.
In men younger than age 75 years, the USPSTF found inadequate evidence to determine whether
treatment for prostate cancer detected by screening improves health outcomes compared with
treatment after clinical detection.
The USPSTF found convincing evidence that treatment for prostate cancer detected by screening
causes moderate-to-substantial harms, such as erectile dysfunction, urinary incontinence, bowel
dysfunction, and death. These harms are especially important because some men with prostate cancer
who are treated would never have developed symptoms related to cancer during their lifetime.
There is also adequate evidence that the screening process produces at least small harms, including
pain and discomfort associated with prostate biopsy and psychological effects of false-positive test
results.
The USPSTF recommends against screening for prostate cancer in men age 75 years or
older.
Rationale: In men age 75 years or older, the USPSTF found adequate evidence that the incremental
benefits of treatment for prostate cancer detected by screening are small to none.
Given the uncertainties and controversy surrounding prostate cancer screening in men younger than
age 75 years, a clinician should not order the PSA test without first discussing with the patient the
potential but uncertain benefits and the known harms of prostate cancer screening and treatment.
Men should be informed of the gaps in the evidence and should be assisted in considering their
personal preferences before deciding whether to be tested.
–
US Preventive Services Task Force, Agency for Healthcare Research and Quality, US Department of Health & Human Services.
Note that other organizations (e.g., American Cancer Society, American Academy of Family Physicians, American College of
Physicians, National Cancer Institute) may have slightly different screening guidelines.
Note: Due to recent
(2008) changes in clinical
recommendations
against routine PSA
testing, it is anticipated
that testing levels will
begin to decline.
PSA Testing and/or Digital Rectal Examination
Among men age 50 and older, more than three-fourths (77.4%) have had a
PSA (prostate-specific antigen) test and/or a digital rectal examination for
prostate problems within the past two years.
Have Had a Prostate Screening in the Past 2 Years
(Among Total Area Men 50+, 2011)
100%
80%
77.4%
70.5%
60%
40%
20%
0%
Total Area Men 50+
United States Men 50+
Notes:
● Asked of all male respondents aged 50 and older.
62
Female Breast Cancer Screening
The US Preventive Services Task Force (USPSTF) recommends screening mammography, with
or without clinical breast examination (CBE), every 1-2 years for women age 40 and older.
Rationale: The USPSTF found fair evidence that mammography screening every 12-33 months
significantly reduces mortality from breast cancer. Evidence is strongest for women age 50-69, the age
group generally included in screening trials. For women age 40-49, the evidence that screening
mammography reduces mortality from breast cancer is weaker, and the absolute benefit of
mammography is smaller, than it is for older women. Most, but not all, studies indicate a mortality
benefit for women undergoing mammography at ages 40-49, but the delay in observed benefit in
women younger than 50 makes it difficult to determine the incremental benefit of beginning
screening at age 40 rather than at age 50.
The absolute benefit is smaller because the incidence of breast cancer is lower among women in their
40s than it is among older women. The USPSTF concluded that the evidence is also generalizable to
women age 70 and older (who face a higher absolute risk for breast cancer) if their life expectancy is
not compromised by comorbid disease. The absolute probability of benefits of regular mammography
increase along a continuum with age, whereas the likelihood of harms from screening (false-positive
results and unnecessary anxiety, biopsies, and cost) diminish from ages 40-70. The balance of benefits
and potential harms, therefore, grows more favorable as women age. The precise age at which the
potential benefits of mammography justify the possible harms is a subjective choice. The USPSTF did
not find sufficient evidence to specify the optimal screening interval for women age 40-49.
–
Mammography
Among women aged 50-74, 76.6% have had a mammogram within the past
two years.
 Similar to the statewide figure (which reflects all women 50+).
Have Had a Mammogram in the Past Two Years
(Among Total Area Women 50-74, 2011)
100%
80%
76.6%
83.0%
79.9%
60%
40%
20%
0%
Total Area Women 50-74
California* Women 50+
United States Women 50-74
Notes:
● Asked of all female respondents aged 50 to 74 and older.
● *Note that state data reflects all women 50 and older (compared with women 50-74 represented in the county and US figures.
Note that, among women 40 and older, 76.2% have had a mammogram within the
past two years.
63
Cervical Cancer Screenings
The US Preventive Services Task Force (USPSTF) strongly recommends screening for cervical
cancer in women who have been sexually active and have a cervix.
Rationale: The USPSTF found good evidence from multiple observational studies that screening with
cervical cytology (Pap smears) reduces incidence of and mortality from cervical cancer. Direct evidence
to determine the optimal starting and stopping age and interval for screening is limited. Indirect
evidence suggests most of the benefit can be obtained by beginning screening within 3 years of onset
of sexual activity or age 21 (whichever comes first) and screening at least every 3 years. The USPSTF
concludes that the benefits of screening substantially outweigh potential harms.
The USPSTF recommends against routinely screening women older than age 65 for cervical cancer if
they have had adequate recent screening with normal Pap smears and are not otherwise at high risk
for cervical cancer.
Rationale: The USPSTF found limited evidence to determine the benefits of continued screening in
women older than 65. The yield of screening is low in previously screened women older than 65 due
to the declining incidence of high-grade cervical lesions after middle age. There is fair evidence that
screening women older than 65 is associated with an increased risk for potential harms, including
false-positive results and invasive procedures. The USPSTF concludes that the potential harms of
screening are likely to exceed benefits among older women who have had normal results previously
and who are not otherwise at high risk for cervical cancer.
The USPSTF recommends against routine Pap smear screening in women who have had a total
hysterectomy for benign disease.
Rationale: The USPSTF found fair evidence that the yield of cytologic screening is very low in women
after hysterectomy and poor evidence that screening to detect vaginal cancer improves health
outcomes. The USPSTF concludes that potential harms of continued screening after hysterectomy are
likely to exceed benefits.
–
Pap Smear Testing
Among women aged 21 to 65, 90.2% have had a Pap smear within the past
three years.
 More favorable than the California figure (which reflects all women 18+).
 Comparable to the Healthy People 2020 target (93% or higher).
Have Had a Pap Smear in the Past 3 Years
(Among Total Area Women 21-65, 2011)
100%
Healthy People 2020 Target = 93% or Higher
90.2%
84.1%
84.7%
California* Women 18+
United States Women 21-65
80%
60%
40%
20%
0%
Total Area Women 21-65
Notes:
● Asked of female respondents aged 21 to 65.
● *Note that the California percentage represents all women aged 18 and older.
64
Colorectal Cancer Screenings
The USPSTF recommends screening for colorectal cancer using fecal occult blood testing,
sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until
age 75 years.
The evidence is convincing that screening for colorectal cancer with fecal occult blood testing,
sigmoidoscopy, or colonoscopy detects early-stage cancer and adenomatous polyps. There is
convincing evidence that screening with any of the three recommended tests (FOBT, sigmoidoscopy,
colonoscopy) reduces colorectal cancer mortality in adults age 50 to 75 years. Follow-up of positive
screening test results requires colonoscopy regardless of the screening test used.
–
Sigmoidoscopy/Colonoscopy
Among adults age 50 and older, just over 2 in 3 (67.1%) have had a
sigmoidoscopy or colonoscopy at some point in their lives.
Have Ever Had a Sigmoidoscopy/Colonoscopy Exam
(Among Total Area Adults 50+, 2010)
100%
80%
72.0%
67.1%
59.8%
60%
40%
20%
0%
Total Area 50+
California 50+
United States 50+
Notes:
● Asked of all respondents aged 50 and older.
65
Blood Stool Testing
Among adults age 50 and older, 51.6% have had a blood stool test (aka
“fecal occult blood test”) within the past two years.
 More favorable than national findings.
Have Had a Blood Stool Test in the Past 2 Years
(Among Total Area Adults 50+, 2010)
100%
80%
60%
51.6%
40%
27.8%
28.3%
California 50+
United States 50+
20%
0%
Total Area 50+
Notes:
66
Respiratory Disease
Asthma and chronic obstructive pulmonary disease (COPD) are significant public health burdens.
Specific methods of detection, intervention, and treatment exist that may reduce this burden and
promote health.
Asthma is a chronic inflammatory disorder of the airways characterized by episodes of reversible
breathing problems due to airway narrowing and obstruction. These episodes can range in severity
from mild to life threatening. Symptoms of asthma include wheezing, coughing, chest tightness, and
shortness of breath. Daily preventive treatment can prevent symptoms and attacks and enable
individuals who have asthma to lead active lives.
COPD is a preventable and treatable disease characterized by airflow limitation that is not fully
reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory
response of the lung to noxious particles or gases (typically from exposure to cigarette smoke).
Treatment can lessen symptoms and improve quality of life for those with COPD.
Several additional respiratory conditions and respiratory hazards, including infectious agents and
occupational and environmental exposures, are covered in other areas of Healthy People 2020.
Examples include tuberculosis, lung cancer, acquired immunodeficiency syndrome (AIDS), pneumonia,
occupational lung disease, and smoking. Sleep Health is now a separate topic area of Healthy People
2020.
Currently in the United States, more than 23 million people have asthma. Approximately 13.6 million
adults have been diagnosed with COPD, and an approximately equal number have not yet been
diagnosed. The burden of respiratory diseases affects individuals and their families, schools,
workplaces, neighborhoods, cities, and states. Because of the cost to the healthcare system, the
burden of respiratory diseases also falls on society; it is paid for with higher health insurance rates,
lost productivity, and tax dollars. Annual healthcare expenditures for asthma alone are estimated at
$20.7 billion.
Asthma. The prevalence of asthma has increased since 1980. However, deaths from asthma have
decreased since the mid-1990s. The causes of asthma are an active area of research and involve both
genetic and environmental factors.
Risk factors for asthma currently being investigated include:
 Having a parent with asthma
 Sensitization to irritants and allergens
 Respiratory infections in childhood
 Overweight
Asthma affects people of every race, sex, and age. However, significant disparities in asthma morbidity
and mortality exist, in particular for low-income and minority populations. Populations with higher
rates of asthma include: children; women (among adults) and boys (among children); African
Americans; Puerto Ricans; people living in the Northeast United States; people living below the
Federal poverty level; and employees with certain exposures in the workplace.
While there is not a cure for asthma yet, there are diagnoses and treatment guidelines that are aimed
at ensuring that all people with asthma live full and active lives.
COPD. COPD is the fourth leading cause of death in the United States. In 2006, approximately
120,000 individuals died from COPD, a number very close to that reported for lung cancer deaths
(approximately 158,600) in the same year. In nearly 8 out of 10 cases, COPD is caused by exposure to
cigarette smoke. In addition, other environmental exposures (such as those in the workplace) may
cause COPD.
Genetic factors strongly influence the development of the disease. For example, not all smokers
develop COPD. Quitting smoking may slow the progression of the disease. Women and men are
affected equally, yet more women than men have died of COPD since 2000.
–
[NOTE: COPD was changed to chronic lower respiratory disease (CLRD) with the introduction of ICD-10 codes. CLRD is used in vital
statistics reporting, but COPD is still widely used and commonly found in surveillance reports.]
67
Age-Adjusted Respiratory Disease Deaths
Chronic Lower Respiratory Disease Deaths (CLRD)
Between 2005 and 2007, there was an annual average age-adjusted CLRD
County.
 Less favorable than that found statewide.
CLRD: Age-Adjusted Mortality
200
150
100
61.5
39.3
41.5
California
United States
50
0
Notes:
 CLRD mortality appears notably higher among Whites in San Bernadino
County.
CLRD: Age-Adjusted Mortality by Race
200
150
100
82.0
61.5
50
23.3
33.1
0
Non-Hispanic White
Hispanic
Non-Hispanic Other
Notes:
68
 CLRD mortality across the county has decreased over time, mirroring the
trends reported both statewide and nationwide. It remains, however, well
above state and national rates.
CLRD: Age-Adjusted Mortality Trends
150
100
50
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
San Bernardino Co.
68.0
65.7
65.3
66.0
66.3
65.1
61.5
California
45.2
43.6
43.3
42.0
41.7
40.2
39.3
United States
44.4
43.8
43.5
42.6
42.6
41.6
41.5
Notes:
For prevalence of
vaccinations for
pneumonia and
influenza, see also
“Immunization &
Infectious Disease.”
Between 2005 and 2007, there was an annual average age-adjusted
pneumonia/influenza mortality rate of 22.9 deaths per 100,000 population
in San Bernadino County.
 Higher than found statewide.
 Higher than the national rate.
Pneumonia/Influenza: Age-Adjusted Mortality
100
80
60
40
22.9
21.3
California
20
18.1
0
United States
Notes:
69
 The pneumonia/influenza mortality rate in the county highest among
Whites.
Pneumonia/Influenza: Age-Adjusted Mortality by Race
100
80
60
40
24.2
19.8
21.6
22.9
Hispanic
Non-Hispanic Other
20
0
Non-Hispanic White
Notes:
 San Bernadino County pneumonia/influenza mortality rates have shown a
decline in recent years, similar to what is found statewide and nationally.
Pneumonia/Influenza: Age-Adjusted Mortality Trends
100
80
60
40
20
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
San Bernardino Co.
23.9
28.9
29.0
27.7
27.1
24.8
22.9
California
24.6
28.1
27.1
25.5
24.3
22.8
21.3
United States
23.0
22.8
22.2
21.5
20.7
19.3
18.1
Notes:
70
Prevalence of Respiratory Conditions
Survey respondents
were next asked to
indicate whether they
suffer from or have
been diagnosed with
various respiratory
conditions, including
asthma, nasal/hay fever
allergies, sinusitis, and/
or chronic lung disease.
Nasal/Hay Fever Allergies
A total of 28.2% of Total Area adults currently suffer from or have been
diagnosed with nasal/hay fever allergies.
Prevalence of Nasal/Hay Fever Allergies
100%
80%
60%
40%
29.5%
29.3%
Apple Valley
(PSA)
Hesperia
(PSA)
26.2%
28.0%
28.9%
28.2%
27.3%
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
20%
0%
Notes:
Sinusitis
A total of 13.2% of Total Area adults suffer from sinusitis.
 More favorable than the national prevalence.
Prevalence of Sinusitis
100%
80%
60%
40%
20%
15.3%
16.6%
11.4%
14.1%
19.4%
8.9%
13.2%
0%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
Notes:
71
Chronic Lung Disease
A total of 10.5% of Total Area adults suffer from chronic lung disease.
Prevalence of Chronic Lung Disease
100%
80%
60%
40%
20%
7.5%
9.5%
11.8%
9.9%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
13.0%
10.5%
8.4%
SSA
Overall
Total
Area
United
States
0%
Notes:
Asthma
Adults
A total of 8.7% of Total Area adults currently suffer from asthma.
 Similar to the statewide prevalence.
No significant difference between service areas.
No significant difference by community within the Primary Service Area.
Currently Have Asthma
100%
80%
60%
40%
20%
12.4%
11.6%
5.1%
9.2%
6.8%
8.7%
7.8%
7.5%
PSA
Overall
SSA
Overall
Total
Area
California
United
States
0%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
Notes:
72
Adults with asthma were next asked to consider the number of days over the past
year on which their asthma interfered with work or usual activities.
While more than one-half (57.7%) indicated that asthma did not affect their
work or usual activities at all in the past year, 13.9% of asthmatic
respondents report that their lives were affected daily by their asthma.
Number of Days in Past Year When
Asthma Interfered With Work or Usual Activities
(Among Residents With Asthma; Total Area, 2011)
Daily 13.9%
None 57.7%
Three/More 34.0%
Two 4.5%
Sources:
Notes:
One 3.8%
 Asked of all respondents with asthma.
Children
Among Total Area children under age 18, 8.2% currently have asthma.
 Comparable to national findings.
 Viewed by age and gender, differences in asthma prevalence are not
statistically significant.
Child Has Asthma
(Among Parents of Children <18)
100%
80%
60%
40%
20%
10.8%
5.0%
11.3%
8.4%
3.5%
8.2%
6.8%
Total Area
United States
0%
Total Area
Boys
Total Area
Girls
Total Area
Children 5/Under
Total Area
Children 6-12
Total Area
Teens
Notes:
● Asked of all respondents with children under 18 at home.
73
Injury & Violence
Injuries and violence are widespread in society. Both unintentional injuries and those caused by acts of
violence are among the top 15 killers for Americans of all ages. Many people accept them as
“accidents,” “acts of fate,” or as “part of life.” However, most events resulting in injury, disability, or
death are predictable and preventable.
Injuries are the leading cause of death for Americans ages 1 to 44, and a leading cause of disability for
all ages, regardless of sex, race/ethnicity, or socioeconomic status. More than 180,000 people die from
injuries each year, and approximately 1 in 10 sustains a nonfatal injury serious enough to be treated in
a hospital emergency department.
Beyond their immediate health consequences, injuries and violence have a significant impact on the
well-being of Americans by contributing to:
 Premature death
 Disability
 Poor mental health
 High medical costs
 Lost productivity
The effects of injuries and violence extend beyond the injured person or victim of violence to family
members, friends, coworkers, employers, and communities.
Numerous factors can affect the risk of unintentional injury and violence, including individual
behaviors, physical environment, access to health services (ranging from pre-hospital and acute care to
rehabilitation), and social environment (from parental monitoring and supervision of youth to peer
group associations, neighborhoods, and communities).
Interventions addressing these social and physical factors have the potential to prevent unintentional
injuries and violence. Efforts to prevent unintentional injury may focus on:
 Modifications of the environment
 Improvements in product safety
 Legislation and enforcement
 Education and behavior change
 Technology and engineering
Efforts to prevent violence may focus on:
 Changing social norms about the acceptability of violence
 Improving problem-solving skills (for example, parenting, conflict resolution, coping)
 Changing policies to address the social and economic conditions that often give rise to violence
–
74
Motor vehicle accidents, poisoning, and falls accounted for 87.5% of
accidental deaths across San Bernadino County in 2007.
(San Bernardino County, 2007)
Other 12.5%
Falls 9.0%
Motor Vehicle
Accidents 56.5%
Poisoning/Noxious
Substances 22.0%
Notes:
Unintentional Injury
Age-Adjusted Unintentional Injury Deaths
unintentional injury mortality rate of 32.0 deaths per 100,000 population
across San Bernadino County.
 Similar to the California rate.
 More favorable than the national rate.
 Satisfies the Healthy People 2020 target (36.0 or lower).
Unintentional Injuries: Age-Adjusted Mortality
100
80
60
39.7
40
32.0
31.8
California
20
0
United States
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IVP-11]
Notes:
75
 Mortality rates are higher among San Bernadino County Whites.
Unintentional Injuries: Age-Adjusted Mortality by Race
100
80
60
38.0
40
32.0
27.9
25.5
Hispanic
Non-Hispanic Other
20
0
Non-Hispanic White
Notes:
 There is an overall upward trend in unintentional injury mortality rates
across San Bernadino County, echoing the increasing trends reported in
California and across the US overall.
Unintentional Injuries: Age-Adjusted Mortality Trends
100
80
60
40
20
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
Healthy People 2020
36.0
36.0
36.0
36.0
36.0
36.0
36.0
28.5
29.3
29.5
30.7
31.4
31.8
32.0
California
26.6
27.0
28.4
30.4
30.9
31.3
31.8
United States
35.3
35.8
36.7
37.4
38.1
39.0
39.7
Notes:
76
Motor Vehicle Safety
Age-Adjusted Motor-Vehicle Related Deaths
Between 2005 and 2007, there was an annual average age-adjusted motor
vehicle crash mortality rate of 16.7 deaths per 100,000 population across
the county.
 Higher than found statewide.
 Higher than found nationally.
 Fails to satisfy the Healthy People 2020 target (12.4 or lower).
Motor Vehicle Crashes: Age-Adjusted Mortality
50
40
30
20
16.7
14.3
11.7
10
0
California
United States
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IVP-13.1]
Notes:
 The motor vehicle crash mortality rate is highest among Whites in San
Bernardino County.
Motor Vehicle Crashes: Age-Adjusted Mortality by Race
100
80
60
40
20
18.7
16.1
14.2
16.7
Non-Hispanic White
Hispanic
Non-Hispanic Other
0
Notes:
77
 Mortality rates across San Bernadino County increased over the past decade,
mirroring the state trend. On the other hand, rates decreased slightly across
the US during this time.
Motor Vehicle Crashes: Age-Adjusted Mortality Trends
50
40
30
20
10
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
Healthy People 2020
12.4
12.4
12.4
12.4
12.4
12.4
12.4
15.4
15.8
16.3
17.0
17.4
17.1
16.7
California
10.9
11.3
11.8
12.1
12.1
11.9
11.7
United States
14.8
15.0
14.9
14.9
14.7
14.6
14.3
Notes:
Seat Belt Usage - Adults
Most Total Area adults (94.0%) report “always” wearing a seat belt when
driving or riding in a vehicle.
 More favorable than the percentage found nationally.
 Similar to the Healthy People 2020 objective of 92.4% or higher.
Within the Primary Service Area, no differences to report.
“Always” Wear a Seat Belt
When Driving or Riding in a Vehicle
100%
94.4%
92.5%
95.8%
94.4%
92.3%
94.0%
85.3%
80%
60%
40%
20%
0%
Apple Valley
(PSA)
Sources: ●
●
●
Notes:
●
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IPV-15]
78
 Residents of “Other” races are more likely to report consistent seat belt
usage.
“Always” Wear a Seat Belt
When Driving or Riding in a Vehicle
(Total Area, 2011)
100%
92.6%
95.3%
92.9%
93.8%
Women
18 to 39
40 to 64
96.7%
98.6%
92.9%
94.3%
93.6%
93.6%
<200%
FPL
200%+
FPL
White
Hispanic
94.0%
80%
60%
40%
20%
0%
Men
Sources: ●
●
Notes:
●
●
65+
Other
Total
Area
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IPV-15]
Seat Belt Usage - Children
A full 95.6% of Total Area parents report that their child (age 0 to 17)
“always” wears a seat belt (or appropriate car seat for younger children) when
riding in a vehicle.
 Statistically similar to what is found nationally.
 Among children under age 5, 100% are reported to consistently use
appropriate seat belts/safety seats (note that this small sample size is
considered to be unreliable).
 Among children age 5-17, 94.1% report consistent safety belt usage, similar
to that found nationally.
Child “Always” Wears a Seatbelt or
Appropriate Restraint When Riding in a Vehicle
(Among Parents of Children Age 0-17; Total Area, 2011)
100%
100.0%
94.1%
95.6%
Total Area Age 5-17
Total Area Age 0-17
91.6%
80%
60%
40%
20%
0%
Total Area Age 0-4
United States Age 0-17
Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Items 139, 163-164]
Notes:
79
Bicycle Safety
More than 4 in 10 Total Area children age 5 to 16 (44.3%) are reported to
“always” wear a helmet when riding a bicycle.
 Similar to the national prevalence.
 Note that helmet use drops off considerably among Total Area teens.
Child “Always” Wears a Helmet When Riding a Bicycle
(Among Parents of Children 5 to 16, 2011)
100%
80%
60%
57.2%
53.1%
44.3%
35.3%
40%
28.1%
20%
0%
Total Area
Children 5/Under
Total Area
Children 6-12
Total Area
Teens
Total Area
United States
● Asked of all respondents with children aged 5 to 16 at home.
Notes:
Firearm Safety
Between 2005 and 2007, there was an annual average age-adjusted firearmrelated mortality rate of 11.2 deaths per 100,000 population across San
Bernadino County.
 Less favorable than found statewide.
 Less favorable than found nationally.
 Fails to satisfy the Healthy People 2020 objective of 9.2.
Firearms-Related Deaths: Age-Adjusted Mortality
50
40
30
20
11.2
10
9.2
10.3
California
United States
0
Notes:
80
 The county's firearm-related mortality rate is much higher among “Other”
races when compared with Whites and Hispanics.
Firearms-Related Deaths: Age-Adjusted Mortality by Race
100
80
60
40
17.1
20
9.9
8.5
Non-Hispanic White
Hispanic
11.2
0
Non-Hispanic Other
Notes:
 Mortality rates across the county decreased slowly over the past decade.
Across California and the US overall, rates have been stable.
Firearms-Related Deaths: Age-Adjusted Mortality Trends
50
40
30
20
10
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
Healthy People 2020
9.2
9.2
9.2
9.2
9.2
9.2
2005-2007
9.2
12.7
12.3
12.1
12.3
12.3
11.6
11.2
California
9.3
9.5
9.6
9.6
9.5
9.3
9.2
United States
10.3
10.3
10.4
10.3
10.2
10.2
10.3
Notes:
81
Presence of Firearms in Homes
Survey respondents
were further asked
about the presence of
weapons in the home:
“Are there ny
firearms now kept in or
around your home,
including those kept in
a garage, outdoor
storage area, truck, or
car? For the purposes
of this inquiry,
firerms’ include
pistols, shotguns, rifles,
and other types of
guns, but do NOT
include starter pistols,
BB guns, or guns that
cnnot fire.”
Overall, just over 3 in 10 (31.1%) Total Area adults have a firearm kept in or
around their home.
 Lower than the national prevalence.
 Among Total Area households with children, 25.8% have a firearm kept in
or around the house (lower than reported nationally).
Have a Firearm Kept in or Around the Home
100%
Among households with children, 25.8% have a firearm kept in or around the home (vs 34.4% across the nation).
80%
60%
40%
34.8%
33.4%
29.7%
32.2%
Victorville
(PSA)
PSA
Overall
37.9%
25.6%
31.1%
20%
0%
Apple Valley
(PSA)
Hesperia
(PSA)
SSA
Overall
Total
Area
United
States
Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Items 64, 161]
Notes:
Reports of firearms in or around the home are more prevalent among the following
respondent groups:
 Residents aged 40 and older.
 Higher-income households.
 White respondents.
Have a Firearm Kept in or Around the House
(Total Area, 2011)
100%
80%
60%
45.9%
40%
30.1%
37.4%
32.0%
47.0%
32.6%
31.1%
24.1%
20%
13.8%
17.6%
16.9%
Hispanic
Other
0%
Men
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Total
Area
Notes:
82
Among Total Area households with firearms, 15.8% report that there is at
least one weapon that is kept unlocked and loaded.
 Statistically similar to that found nationally.
Household Has an Unlocked/Loaded Firearm
(Among Respondents With Firearms at Home; Total Area 2011)
100%
80%
60%
40%
20%
15.8%
16.9%
Total Area
United States
0%
Notes:
● Asked of all respondents with firearms in or around the home.
Intentional Injury (Violence)
Age-Adjusted Homicide Deaths
homicide rate of 8.7 deaths per 100,000 population across the county.
 Less favorable than the rate found statewide.
RELATED ISSUE:
See also Suicide in the
Mental Health & Mental
Disorders section
of this report.
Homicide: Age-Adjusted Mortality
50
40
30
20
10
8.7
6.7
6.1
California
United States
0
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IPV-29]
Notes:
83
 Homicide rates are notably higher among “Other” races when compared
with Whites and Hispanics in San Bernadino County.
Homicide: Age-Adjusted Mortality by Race
50
40
30
18.6
20
8.7
8.5
10
4.5
0
Non-Hispanic White
Hispanic
Non-Hispanic Other
Notes:
 Homicide rates increased in San Bernadino County during much of the past
decade, with declines in the most recent reporting periods.
Homicide: Age-Adjusted Mortality Trends
50
40
30
20
10
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
Healthy People 2020
5.5
5.5
5.5
5.5
5.5
5.5
5.5
7.5
7.8
8.2
8.7
9.1
8.9
8.7
California
6.0
6.3
6.6
6.8
6.8
6.9
6.7
United States
6.3
6.4
6.4
6.0
6.0
6.1
6.1
Notes:
84
Violent Crime
Violent Crime Rates
Violent crime is composed of
four offenses (FBI Index
offenses): murder and nonnegligent manslaughter;
forcible rape; robbery; and
aggravated assault.
Note that the quality of
crime data can vary widely
from location to location,
depending on the
consistency and
completeness of reporting
among various jurisdictions.
Between 2006 and 2008, there was an annual average violent crime rate of
500.9 offenses per 100,000 population in San Bernadino County.
 Comparable to the California rate for the same period.
Violent Crime Rates
(2006-2008 Annual Average Offenses per 100,000 Population)
1,500
1,000
500.9
503.7
California
465.0
500
0
United States
Sources: ● California Uniform Crime Report.
:
● US Department of Justice, Federal Bureau of Investigation, Crime in the US
Notes:
● Rates are offenses per 100,000 population among agencies reporting.
 County crime rates have declined in recent years, echoing the state and
national trends.
Violent Crime Rates
(Annual Average Offenses per 100,000 Population)
1,400
1,200
1,000
800
600
400
200
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
543.8
548.9
554.0
533.6
514.0
497.2
495.3
500.9
California
608.9
601.8
588.1
566.1
540.4
523.4
512.6
503.7
United States
511.3
501.8
491.6
477.8
469.3
468.6
469.8
465.0
Sources: ● California Uniform Crime Report.
● US Department of Justice, Federal Bureau of Investigation, Crime in the US
Notes:
● Rates are offenses per 100,000 population among agencies reporting.
85
Self-Reported Violence
A total of 3.1% of Total Area adults acknowledge being the victim of a
violent crime in the past five years.
Have Been the Victim of a Violent Crime in the Past 5 Years
100%
80%
60%
40%
20%
4.2%
3.9%
2.0%
3.2%
2.4%
3.1%
1.6%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
0%
Notes:
Family Violence
Between 2007 and 2009, there was an annual average domestic violence
rate of 401.4 offenses per 100,000 population across San Bernadino County.
 Lower than the California rate for the same period.
Domestic Violence Rates
(2007-2009 Annual Average Offenses per 100,000 Population)
1,000
800
600
490.5
401.4
400
200
0
California
Sources: ● California Department of Justice.
Notes:
● Rates are offenses per 100,000 population.
86
 Domestic violence rates decreased in the past decade across the county; the
same can be said for state rates during this time.
Domestic Violence Rates
(Annual Average Offenses per 100,000 Population)
1,000
800
600
400
200
0
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
484.2
483.5
493.4
494.0
493.9
467.0
433.9
401.4
California
577.4
569.6
571.8
562.2
545.5
526.3
505.6
490.5
Sources: ● California Department of Justice.
Notes:
● Rates are offenses per 100,000 population.
Self-Reported Family Violence
Respondents were told:
“By an intimate partner,
I mean any current
or former spouse,
boyfriend, or girlfriend.
Someone you were
dating, or romantically or
sexually intimate with
would also be considered
an intimate partner.”
A total of 19.2% of Total Area adults report that they have ever been
threatened with physical violence by an intimate partner.

Higher than reported nationally.
Within the Primary Service Area, lowest in Apple Valley.
One-fifth (20.9%) of respondents acknowledges that they have ever been
hit, slapped, pushed, kicked, or otherwise hurt by an intimate partner.
 Less favorable than national findings.
Significantly higher (worse) in the Secondary Service Area than in the
Primary Service Area.
No significant differences within the Primary Service Area.
Have Ever Been Hit, Slapped, Pushed,
Kicked, or Hurt in Any Way by an Intimate Partner
100%
A total of 19.2% of respondents report being threatened with physical violence by an intimate partner (vs. 11.7% across the US).
80%
60%
40%
30.5%
21.1%
20%
15.3%
19.0%
18.7%
Victorville
(PSA)
PSA
Overall
20.9%
13.5%
0%
Apple Valley
(PSA)
Hesperia
(PSA)
SSA
Overall
Total
Area
United
States
Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey. [Items 62-63]
Notes:
87
 Reports of domestic violence are also notably higher among non-Hispanic
respondents.
Have Ever Been Hit, Slapped, Pushed,
Kicked, or Hurt in Any Way by an Intimate Partner
(Total Area, 2011)
100%
80%
60%
40%
30.2%
24.4%
20%
21.2%
17.4%
23.1%
22.8%
22.6%
23.7%
20.9%
16.5%
13.9%
0%
Men
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
Notes:
Child Abuse
Between 2007 and 2009, there was an annual average child abuse
allegation rate of 57.7 allegations per 100,000 population across San
Bernadino County.
 Higher than the California rate for the same period.
Child Abuse Rates
(2007-2009 Annual Average Allegations per 1,000 Children)
500
400
300
200
100
57.7
48.4
California
0
Sources: ● Center for Social Services Research, University of Berkeley.
Notes:
● Rates are offenses per 1,000 children .
88
 San Bernadino County child abuse allegation rates began to decrease after
2005.
Child Abuse Rates
(Annual Average Allegations per 1,000 Children)
500
400
300
200
100
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
63.0
63.9
64.2
64.8
65.7
65.5
63.3
60.2
57.7
California
50.2
50.2
50.1
49.3
48.7
48.6
48.8
48.4
48.4
Sources: ● Center for Social Services Research, University of Berkeley.
Notes:
● Rates are allegations per 1,000 Children .
89
Diabetes
Diabetes mellitus occurs when the body cannot produce or respond appropriately to insulin. Insulin is
a hormone that the body needs to absorb and use glucose (sugar) as fuel for the body's cells. Without
a properly functioning insulin signaling system, blood glucose levels become elevated and other
metabolic abnormalities occur, leading to the development of serious, disabling complications. Many
forms of diabetes exist; the three common types are Type 1, Type 2, and gestational diabetes.
Effective therapy can prevent or delay diabetic complications. However, almost 25% of Americans
with diabetes mellitus are undiagnosed, and another 57 million Americans have blood glucose levels
that greatly increase their risk of developing diabetes mellitus in the next several years. Few people
receive effective preventative care, which makes diabetes mellitus an immense and complex public
health challenge.
Diabetes mellitus affects an estimated 23.6 million people in the United States and is the 7th leading
cause of death. Diabetes mellitus:
 Lowers life expectancy by up to 15 years.
 Increases the risk of heart disease by 2 to 4 times.
 Is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness.
In addition to these human costs, the estimated total financial cost of diabetes mellitus in the US in
2007 was $174 billion, which includes the costs of medical care, disability, and premature death.
The rate of diabetes mellitus continues to increase both in the United States and throughout the
world. Due to the steady rise in the number of persons with diabetes mellitus, and possibly earlier
onset of type 2 diabetes mellitus, there is growing concern about the possibility that the increase in
the number of persons with diabetes mellitus and the complexity of their care might overwhelm
existing healthcare systems.
People from minority populations are more frequently affected by type 2 diabetes. Minority groups
constitute 25% of all adult patients with diabetes in the US and represent the majority of children and
adolescents with type 2 diabetes.
Lifestyle change has been proven effective in preventing or delaying the onset of type 2 diabetes in
high-risk individuals.
–
Age-Adjusted Diabetes Deaths
diabetes mortality rate of 32.0 deaths per 100,000 population across San
Bernadino County.
 Less favorable than that found statewide.
90
Diabetes: Age-Adjusted Mortality
100
80
60
40
32.0
22.5
23.5
California
United States
20
0
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective D-3]
Notes:
● The Healthy People 2010 target for Diabetes is adjusted to account for only diabetes mellitus coded deaths.
 Diabetes mortality rates are notably higher among Hispanics and non-Whites
in San Bernadino County.
Diabetes: Age-Adjusted Mortality by Race
100
80
60
38.7
40
40.4
32.0
27.7
20
0
Non-Hispanic White
Hispanic
Non-Hispanic Other
Notes:
91
 Diabetes mortality has been stable across the county in recent years.
Diabetes: Age-Adjusted Mortality Trends
100
80
60
40
20
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
Healthy People 2020 (Adjusted)
19.6
19.6
19.6
19.6
19.6
19.6
19.6
31.6
30.5
31.0
30.8
31.5
31.4
32.0
California
21.7
21.7
22.1
22.5
22.9
22.7
22.5
United States
25.1
25.3
25.4
25.1
24.8
24.2
23.5
Notes:
A total of 14.2% of Total Area adults report having been diagnosed with
diabetes.
 Less favorable than the proportion statewide.
 Less favorable than the national percentage.
100%
80%
60%
40%
20%
19.2%
12.9%
13.3%
12.9%
13.0%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
14.2%
9.1%
10.1%
California
United
States
0%
SSA
Overall
Total
Area
Notes:
92
 Note the positive correlation between diabetes and age (with 36.8% of
seniors with diabetes).
 A higher prevalence of diabetes is reported among adults of “Other” races
in the Total Area.
(Total Area, 2011)
100%
80%
60%
36.8%
40%
27.9%
20%
18.6%
17.0%
14.7%
11.4%
12.3%
12.3%
11.0%
200%+
FPL
White
Hispanic
14.2%
3.5%
0%
Men
Women
18 to 39
40 to 64
65+
<200%
FPL
Other
Total
Area
Notes:
Diabetes Treatment
Among adults with diabetes, most (80.4%) are currently taking insulin or
some type of medication to manage their condition.
Taking Insulin or Other Medication for Diabetes
(Among Diabetics; Total Area, 2011)
No
19.6%
No
22.3%
Yes
77.7%
Yes
80.4%
Total Area Diabetics
Sources:
Notes:
US Diabetics
 Professional Research Consultants, Inc. PRC National Health Survey. 2011.
 Asked of all diabetic respondents.
93
Alzheimer’s Disease
Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—to such an
extent that it interferes with a person's daily life. Dementia is not a disease itself, but rather a set of
symptoms. Memory loss is a common symptom of dementia, although memory loss by itself does not
mean a person has dementia. Alzheimer's disease is the most common cause of dementia, accounting
for the majority of all diagnosed cases.
Alzheimer's disease is the 6th leading cause of death among adults age 18 years and older. Estimates
vary, but experts suggest that up to 5.1 million Americans age 65 years and older have Alzheimer's
disease. These numbers are predicted to more than double by 2050 unless more effective ways to
treat and prevent Alzheimer's disease are found.
–
Age-Adjusted Alzheimer’s Disease Deaths
Alzheimers disease mortality rate of 28.4 deaths per 100,000 population
Alzheimers Disease: Age-Adjusted Mortality
50
40
30
28.4
24.0
22.7
20
10
0
California
United States
Notes:
94
 Alzheimer's disease mortality rates are notably lower among San Bernadino
County Hispanics.
Alzheimers Disease: Age-Adjusted Mortality by Race
50
40
32.3
30
28.4
26.3
20
16.6
10
0
Non-Hispanic White
Hispanic
Non-Hispanic Other
Notes:
 An upward trend in Alzheimer's disease mortality is apparent in San
Bernadino County. Across California and the US, rates have increased
steadily in recent years.
Alzheimers Disease: Age-Adjusted Mortality Trends
50
40
30
20
10
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
18.7
18.6
20.4
22.4
25.5
28.0
28.4
California
16.5
17.0
18.9
20.6
22.4
23.3
24.0
United States
17.9
19.2
20.3
21.2
22.1
22.5
22.7
Notes:
95
Kidney Disease
Age-Adjusted Kidney Disease Deaths
Between 2005 and 2007, there was an annual average age-adjusted kidney
disease mortality rate of 11.7 deaths per 100,000 population across San
Bernadino County.
Kidney Disease: Age-Adjusted Mortality
50
40
30
20
14.5
11.7
8.0
10
0
California
United States
Notes:
 Kidney disease mortality rates are notably higher among adults of “Other”
races in San Bernadino County.
Kidney Disease: Age-Adjusted Mortality by Race
50
40
30
21.3
20
14.0
10
11.7
8.9
0
Non-Hispanic White
Hispanic
Non-Hispanic Other
Notes:
96
 An upward trend in kidney disease mortality is apparent across the county,
similar to the trends reported both statewide and nationwide.
Kidney Disease: Age-Adjusted Mortality Trends
50
40
30
20
10
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
9.9
10.3
11.3
11.8
11.7
11.7
11.7
California
7.0
6.7
7.1
7.4
7.5
7.7
8.0
United States
13.5
13.9
14.2
14.3
14.3
14.4
14.5
Notes:
97
Potentially Disabling Conditions
There are more than 100 types of arthritis. Arthritis commonly occurs with other chronic conditions,
such as diabetes, heart disease, and obesity. Interventions to treat the pain and reduce the functional
limitations from arthritis are important, and may also enable people with these other chronic
conditions to be more physically active. Arthritis affects 1 in 5 adults and continues to be the most
common cause of disability. It costs more than $128 billion per year. All of the human and economic
costs are projected to increase over time as the population ages. There are interventions that can
reduce arthritis pain and functional limitations, but they remain underused. These include: increased
physical activity; self-management education; and weight loss among overweight/obese adults.
Osteoporosis is a disease marked by reduced bone strength leading to an increased risk of fractures
(broken bones). In the United States, an estimated 5.3 million people age 50 years and older have
osteoporosis. Most of these people are women, but about 0.8 million are men. Just over 34 million
more people, including 12 million men, have low bone mass, which puts them at increased risk for
developing osteoporosis. Half of all women and as many as 1 in 4 men age 50 years and older will
have an osteoporosis-related fracture in their lifetime.
RELATED ISSUE:
See also Activity Limitations
in the General Health
Status section of this report.
Chronic back pain is common, costly, and potentially disabling. About 80% of Americans experience
low back pain in their lifetime. It is estimated that each year:
 15%-20% of the population develop protracted back pain.
 2-8% have chronic back pain (pain that lasts more than 3 months).
 3-4% of the population is temporarily disabled due to back pain.
 1% of the working-age population is disabled completely and permanently as a result of low
back pain.
Americans spend at least $50 billion each year on low back pain. Low back pain is the:
 2nd leading cause of lost work time (after the common cold).
 3rd most common reason to undergo a surgical procedure.
 5th most frequent cause of hospitalization.
Arthritis, osteoporosis, and chronic back conditions all have major effects on quality of life, the ability
to work, and basic activities of daily living.
–
Arthritis, Osteoporosis, & Chronic Pain
Prevalence of Arthritis/Rheumatism
Nearly 4 in 10 Total Area adults aged 50+ (39.2%) report suffering from
arthritis or rheumatism.
98
Prevalence of Arthritis/Rheumatism (50+)
100%
80%
60%
39.2%
40%
35.4%
20%
0%
Total Area 50+
United States 50+
Notes:
Prevalence of Osteoporosis
A total of 11.3% of survey respondents age 50 and older have osteoporosis.
 Much lower than that found nationwide.
 Fails to satisfy the Healthy People 2020 objective of 5.3% or lower.
Among adults of all ages (18+), the prevalence of osteoporosis is much
higher in the Primary Service Area than in the Secondary Service Area (not
shown).
Prevalence of Osteoporosis (50+)
100%
80%
60%
40%
27.6%
20%
11.3%
0%
Total Area 50+
Sources: ●
●
●
Notes:
●
United States 50+
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective AOCBC-10]
Asked of all respondents aged 50 and older.
99
Prevalence of Sciatica/Chronic Back Pain
A total of 23.5% of survey respondents suffers from chronic back pain or
sciatica.
Prevalence of Sciatica/Chronic Back Pain
100%
80%
60%
40%
24.1%
27.1%
20.5%
24.2%
20.3%
23.5%
21.5%
Total
Area
United
States
20%
0%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Notes:
Prevalence of Migraines/Severe Headaches
A total of 19.2% of survey respondents reports suffering from migraines or
severe headaches.
Similar findings between service areas.
Prevalence of Migraines/Severe Headaches
100%
80%
60%
40%
20%
17.4%
21.1%
20.6%
19.9%
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
15.8%
19.2%
16.9%
Total
Area
United
States
0%
Apple Valley
(PSA)
SSA
Overall
Notes:
100
Prevalence of Chronic Neck Pain
A total of 10.5% of survey respondents currently suffers from chronic neck
pain.
 Comparable to that found nationwide.
Within the Primary Service Area, no significant difference by community.
Prevalence of Chronic Neck Pain
100%
80%
60%
40%
20%
12.9%
12.8%
6.2%
10.1%
12.4%
10.5%
8.3%
PSA
Overall
SSA
Overall
Total
Area
United
States
0%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
Notes:
101
Vision & Hearing Impairment
Vision Trouble
Vision is an essential part of everyday life, influencing how Americans of all ages learn, communicate,
work, play, and interact with the world. Yet millions of Americans live with visual impairment, and
many more remain at risk for eye disease and preventable eye injury.
The eyes are an important, but often overlooked, part of overall health. Despite the preventable
nature of some vision impairments, many people do not receive recommended screenings and exams.
A visit to an eye care professional for a comprehensive dilated eye exam can help to detect common
vision problems and eye diseases, including diabetic retinopathy, glaucoma, cataract, and age-related
macular degeneration.
These common vision problems often have no early warning signs. If a problem is detected, an eye
care professional can prescribe corrective eyewear, medicine, or surgery to minimize vision loss and
help a person see his or her best.
Healthy vision can help to ensure a healthy and active lifestyle well into a person's later years.
Educating and engaging families, communities, and the nation is critical to ensuring that people have
the information, resources, and tools needed for good eye health.
–
A total of 10.8% of Total Area adults are blind, or have trouble seeing even
when wearing corrective lenses.
RELATED ISSUE:
See also Vision Care
in the Access to
Health Services
 Less favorable than found nationwide.
Within the Primary Service Area, statistically similar findings by community.
 Among Total Area adults age 65 and older, 15.3% have vision trouble.
Prevalence of Blindness/Trouble Seeing
100%
80%
60%
Seniors 15.3%
40%
20%
12.3%
8.4%
9.2%
9.7%
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
15.4%
10.8%
6.9%
0%
Apple Valley
(PSA)
SSA
Overall
Total
Area
United
States
Notes:
102
Hearing Trouble
An impaired ability to communicate with others or maintain good balance can lead many people to
feel socially isolated, have unmet health needs, have limited success in school or on the job.
Communication and other sensory processes contribute to our overall health and well-being.
Protecting these processes is critical, particularly for people whose age, race, ethnicity, gender,
occupation, genetic background, or health status places them at increased risk.
Many factors influence the numbers of Americans who are diagnosed and treated for hearing and
other sensory or communication disorders, such a social determinants (social and economic standings,
age of diagnosis, cost and stigma of wearing a hearing aid, and unhealthy lifestyle choices). In
addition, biological causes of hearing loss and other sensory or communication disorders include:
genetics; viral or bacterial infections; sensitivity to certain drugs or medications; injury; and aging.
As the nation's population ages and survival rates for medically fragile infants and for people with
severe injuries and acquired diseases improve, the prevalence of sensory and communication disorders
is expected to rise.
–
In all, 9.3% of Total Area adults report being deaf or having difficulty
hearing.
 Nearly identical to that found nationwide.
 Among Total Area adults age 65 and older, 22.0% have partial or complete
hearing loss.
Prevalence of Deafness/Trouble Hearing
100%
80%
60%
Seniors 22.0%
40%
20%
7.3%
11.2%
15.2%
5.9%
8.0%
Victorville
(PSA)
PSA
Overall
9.3%
9.6%
Total
Area
United
States
0%
Apple Valley
(PSA)
Hesperia
(PSA)
SSA
Overall
Notes:
103
INFECTIOUS DISEASE
104
Vaccine-Preventable Conditions
The increase in life expectancy during the 20th century is largely due to improvements in child survival;
this increase is associated with reductions in infectious disease mortality, due largely to immunization.
However, infectious diseases remain a major cause of illness, disability, and death. Immunization
recommendations in the United States currently target 17 vaccine-preventable diseases across the
lifespan.
People in the US continue to get diseases that are vaccine-preventable. Viral hepatitis, influenza, and
tuberculosis (TB) remain among the leading causes of illness and death across the nation and account
for substantial spending on the related consequences of infection.
The infectious disease public health infrastructure, which carries out disease surveillance at the
national, state, and local levels, is an essential tool in the fight against newly emerging and reemerging infectious diseases. Other important defenses against infectious diseases include:
 Proper use of vaccines
 Antibiotics
 Screening and testing guidelines
 Scientific improvements in the diagnosis of infectious disease-related health concerns
Vaccines are among the most cost-effective clinical preventive services and are a core component of
any preventive services package. Childhood immunization programs provide a very high return on
investment. For example, for each birth cohort vaccinated with the routine immunization schedule,
society:
 Saves 33,000 lives.
 Prevents 14 million cases of disease.
 Reduces direct healthcare costs by $9.9 billion.
 Saves $33.4 billion in indirect costs.
–
“Incidence rate” or “case
rate” is the number of
new cases of a disease
occurring during a given
period of time.
It is usually expressed as
cases per 100,000
population per year.
Measles, Mumps, Rubella
Between 2007 and 2009, there were no reported cases of measles or rubella
across San Bernadino County; further, the mumps incidence rate during this
time was less than 0.1 cases per 100,000 population.
 The county's pertussis rate between 2007-2009 was 0.4 per 100,000
population, lower than state and national rates.
Reported Case Rates for Vaccine-Preventable Diseases
(2007-2009)
San Bernardino Co.
California
US*
Measles
0.0
0.0
0.0
Mumps
<0.1
0.2
0.9
Rubella
0.0
0.0
0.0
Pertussis
0.4
2.1
4.4
Sources: ●
●
Notes:
●
●
California Department of Public Health.
Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics.
US measles cases include only those infected while in the United States.
US data is 2006 to 2008.
105
Pertussis
 Pertussis incidence has declined in San Bernadino County in the most recent
reporting periods; the same pattern is apparent both statewide and
nationwide.
Pertussis Incidence
(Annual Average Cases per 100,000 Population)
10
8
6
4
2
0
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
San Bernardino Co.
0.7
1.0
1.2
1.4
1.3
0.9
0.5
0.4
California
2.5
2.8
3.2
4.9
5.4
5.0
2.5
2.1
United States
3.0
3.4
5.5
7.2
7.6
5.8
4.4
Sources: ● California Department of Public Health.
● Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics.
Notes:
● Rates are annual average new cases per 100,000 population.
Acute Hepatitis C
The county did not report any cases of hepatitis C between 2007 and 2009.
 Lower than the statewide rate.
 Lower than the national rate.
 Satisfies the Healthy People 2020 target of 0.2 or lower.
Hepatitis C (Acute) Incidence
(2007-2009 Annual Average Cases per 100,000 Population)
10
8
6
4
2
0.0
0.1
California
0.4
0
Sources: ●
●
●
Notes:
●
●
United States
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IID-26]
Rates are annual average new cases per 100,000 population.
US data are 2006-2008 data.
106
 No cases of hepatitis C have been reported across San Bernadino County in
recent years.
Hepatitis C (Acute) Incidence
10
8
6
4
2
0
2005-2007
2006-2008
2007-2009
Healthy People 2020
0.2
0.2
0.2
San Bernardino Co.
0.0
0.0
0.0
California
0.1
0.1
0.1
United States
0.3
0.3
0.4
Sources: ●
●
●
Notes:
●
107
Influenza & Pneumonia Vaccination
Acute respiratory infections, including pneumonia and influenza, are the 8th leading cause of death
in the nation, accounting for 56,000 deaths annually. Pneumonia mortality in children fell by 97% in
the last century, but respiratory infectious diseases continue to be leading causes of pediatric
hospitalization and outpatient visits in the US. On average, influenza leads to more than 200,000
hospitalizations and 36,000 deaths each year. The 2009 H1N1 influenza pandemic caused an estimated
270,000 hospitalizations and 12,270 deaths (1,270 of which were of people younger than age 18)
between April 2009 and March 2010.
–
Flu Vaccinations
Among Total Area seniors, 62.4% received a flu shot (or FluMist® vaccine)
within the past year.
 Statistically comparable to the California finding.
 Statistically comparable to the national finding.
 Fails to satisfy the Healthy People 2020 target (90% or higher).
Have Had a Flu Vaccination in the Past Year
(Among Total Area Seniors 65+, 2011)
100%
80%
71.6%
62.4%
65.1%
60%
40%
20%
0%
Total Area
California
United States
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IID-12.7]
Notes:
● Includes FluMist® as a form of vaccination.
High-Risk Adults
“High-risk” includes adults
who report having been
diagnosed with heart
disease, diabetes or
respiratory disease.
A total of 41.8% of high-risk adults age 18 to 64 received a flu vaccination
(flu shot or FluMist®) within the past year.
 Similar to national findings.
 Fails to satisfy the Healthy People 2020 target (90% or higher).
108
Have Had a Flu Vaccination in the Past Year
(Among Total Area High-Risk Adults <65, 2011)
100%
80%
60%
52.5%
41.8%
40%
20%
0%
Total Area High-Risk <65
Sources: ●
●
●
Notes:
●
●
●
United States High-Risk <65
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IID-12.6]
Asked of all high-risk respondents under 65.
“High-Risk” includes adults aged 18 to 64 who have been diagnosed with heart disease, diabetes or respiratory disease.
Includes FluMist® as a form of vaccination.
Pneumonia Vaccination
Among adults age 65 and older, 64.0% have received a pneumonia
vaccination at some point in their lives.
 Similar to the California figure.
 Similar to the national finding.
 Fails to satisfy the Healthy People 2020 objective of 90% or higher.
Have Ever Had a Pneumonia Vaccine
(Among Total Area Seniors 65+, 2011)
100%
80%
64.0%
68.1%
59.9%
60%
40%
20%
0%
Total Area
California
United States
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IID-13.1]
Notes:
109
High-Risk Adults
“High-risk” includes adults
who report having been
diagnosed with heart
disease, diabetes or
respiratory disease.
A total of 34.0% of high-risk adults age 18 to 64 have ever received a
pneumonia vaccination.
 Fails to satisfy the Healthy People 2020 target (60% or higher).
Have Ever Had a Pneumonia Vaccine
(Among High-Risk Adults <65, 2011)
100%
80%
60%
40%
34.0%
32.0%
Total Area High-Risk <65
United States High-Risk <65
20%
0%
Sources: ●
●
●
Notes:
●
●
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective IID-13.2]
Asked of all high-risk respondents under 65.
“High-Risk” includes adults aged 18 to 64 who have been diagnosed with heart disease, diabetes or respiratory disease.
110
Tuberculosis
Viral hepatitis and tuberculosis (TB) can be prevented, yet healthcare systems often do not make the
best use of their available resources to support prevention efforts. Because the US healthcare system
focuses on treatment of illnesses, rather than health promotion, patients do not always receive
information about prevention and healthy lifestyles. This includes advancing effective and evidencebased viral hepatitis and TB prevention priorities and interventions.
–
Between 2007 and 2009, the annual average tuberculosis incidence rate
(new cases per year) was 3.5 cases per 100,000 population across the
county.
 Below the California incidence rate.
 Below the national incidence rate.
Tuberculosis Incidence
25
20
15
10
7.2
5
4.4
3.5
0
Sources: ●
●
●
Notes:
●
California
United States
Rates are annual average new cases per 100,000 population. National data is 2006-2008 as 2009 rates are not yet available.
111
 San Bernadino County has experienced an overall downward trend in
tuberculosis incidence over the past several years. This decreasing trend is
noted across the state and US as well.
Tuberculosis Incidence
25
20
15
10
5
0
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
Healthy People 2020
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
San Bernardino Co.
4.7
3.9
3.6
3.5
3.2
3.0
3.2
3.5
California
9.6
9.4
9.0
8.6
8.1
7.8
7.6
7.2
United States
5.5
5.3
5.2
5.1
4.9
4.8
4.6
4.4
Sources: ●
●
●
Notes:
●
112
HIV
The HIV epidemic in the United States continues to be a major public health crisis. An estimated 1.1
million Americans are living with HIV, and 1 in 5 people with HIV do not know they have it. HIV
continues to spread, leading to about 56,000 new HIV infections each year.
HIV is a preventable disease, and effective HIV prevention interventions have been proven to reduce
HIV transmission. People who get tested for HIV and learn that they are infected can make significant
behavior changes to improve their health and reduce the risk of transmitting HIV to their sex or drugusing partners. More than 50% of new HIV infections occur as a result of the 21% of people who have
HIV but do not know it.
In the era of increasingly effective treatments for HIV, people with HIV are living longer, healthier,
and more productive lives. Deaths from HIV infection have greatly declined in the United States since
the 1990s. As the number of people living with HIV grows, it will be more important than ever to
increase national HIV prevention and healthcare programs.
There are gender, race, and ethnicity disparities in new HIV infections:
 Nearly 75% of new HIV infections occur in men.
 More than half occur in gay and bisexual men, regardless of race or ethnicity.
 45% of new HIV infections occur in African Americans, 35% in whites, and 17% in Hispanics.
Improving access to quality healthcare for populations disproportionately affected by HIV, such as
persons of color and gay and bisexual men, is a fundamental public health strategy for HIV
prevention. People getting care for HIV can receive:
 Antiretroviral therapy
 Screening and treatment for other diseases (such as sexually transmitted infections)
 HIV prevention interventions
 Mental health services
 Other health services
As the number of people living with HIV increases and more people become aware of their HIV status,
prevention strategies that are targeted specifically for HIV-infected people are becoming more
important. Prevention work with people living with HIV focuses on:
 Linking to and staying in treatment.
 Increasing the availability of ongoing HIV prevention interventions.
 Providing prevention services for their partners.
Public perception in the US about the seriousness of the HIV epidemic has declined in recent years.
There is evidence that risky behaviors may be increasing among uninfected people, especially gay and
bisexual men. Ongoing media and social campaigns for the general public and HIV prevention
interventions for uninfected persons who engage in risky behaviors are critical.
–
Age-Adjusted HIV/AIDS Deaths
HIV/AIDS mortality rate of 3.4 deaths per 100,000 population across San
Bernadino County.
 Lower than found statewide.
 Lower than reported nationally.
 Similar to the Healthy People 2020 target (3.3 or lower).
113
HIV/AIDS: Age-Adjusted Mortality
50
40
30
20
10
3.4
4.0
4.6
California
United States
0
Sources: ● State of California Department of Health and Senior Services
● Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. CDC WONDER Online Query System.
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective HIV-12]
Notes:
 The HIV mortality rate among “Other” races is notably higher than that
reported among Whites and Hispanics in San Bernadino County.
HIV/AIDS: Age-Adjusted Mortality by Race
50
40
30
20
10
3.0
2.9
Non-Hispanic White
Hispanic
5.7
3.4
0
Non-Hispanic Other
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective HIV-12]
Notes:
114
HIV Testing
Among Total Area adults under 65, more than one-half (52.9%) report that
they have been tested for human immunodeficiency virus (HIV).
 Statistically similar to the proportion found nationwide.
No difference by community within the Primary Service Area.
Among Total Area adults aged 18-44, 18.8% report that they have been
tested for human immunodeficiency virus (HIV) within the past year.
 Statistically similar to the proportion found nationwide.
 Similar to the Healthy People 2020 target of 16.9% or higher.
Have Been Tested for HIV in the Past Year
(Among Respondents Aged 18 to 44, 2011)
100%
80%
60%
40%
20%
18.8%
19.9%
Total Area
United States
0%
Sources: ●
●
●
Notes:
●
●
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective HIV-14.1]
Asked of all respondents aged 18 to 44.
Note that the Healthy People 2020 objective is for those aged 15 through 44.
 Total Area men 18-44 less often report having been tested for HIV than Total
Area women 18-44.
Have Been Tested for HIV in the Past Year
(Total Area Adults Aged 18-44, 2011)
100%
80%
60%
40%
22.3%
20%
14.3%
19.5%
22.3%
19.5%
19.3%
18.8%
Other (n=30)
Total Area
13.4%
0%
Men
Sources: ●
●
Notes:
●
●
Women
<200% FPL
200%+ FPL
White
Hispanic
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective HIV-14.1]
Asked of all respondents aged 18 through 44.
115
Sexually Transmitted Diseases
STDs refer to more than 25 infectious organisms that are transmitted primarily through sexual activity.
Despite their burdens, costs, and complications, and the fact that they are largely preventable, STDs
remain a significant public health problem in the United States. This problem is largely unrecognized
by the public, policymakers, and health care professionals. STDs cause many harmful, often
irreversible, and costly clinical complications, such as: reproductive health problems; fetal and
perinatal health problems; cancer; and facilitation of the sexual transmission of HIV infection.
The Centers for Disease Control and Prevention (CDC) estimates that there are approximately 19
million new STD infections each year—almost half of them among young people ages 15 to 24.
Because many cases of STDs go undiagnosed—and some common viral infections, such as human
papillomavirus (HPV) and genital herpes, are not reported to CDC at all—the reported cases of
chlamydia, gonorrhea, and syphilis represent only a fraction of the true burden of STDs in the US.
Untreated STDs can lead to serious long-term health consequences, especially for adolescent girls and
young women. CDC estimates that undiagnosed and untreated STDs cause at least 24,000 women in
the United States each year to become infertile. Several factors contribute to the spread of STDs.
Biological Factors. STDs are acquired during unprotected sex with an infected partner. Biological
factors that affect the spread of STDs include:
 Asymptomatic nature of STDs. The majority of STDs either do not produce any symptoms or
signs, or they produce symptoms so mild that they are unnoticed; consequently, many infected
persons do not know that they need medical care.
 Gender disparities. Women suffer more frequent and more serious STD complications than men
do. Among the most serious STD complications are pelvic inflammatory disease, ectopic
pregnancy (pregnancy outside of the uterus), infertility, and chronic pelvic pain.
 Age disparities. Compared to older adults, sexually active adolescents ages 15 to 19 and young
adults ages 20 to 24 are at higher risk for getting STDs.
 Lag time between infection and complications. Often, a long interval, sometimes years, occurs
between acquiring an STD and recognizing a clinically significant health problem.
Social, Economic and Behavioral Factors. The spread of STDs is directly affected by social,
economic, and behavioral factors. Such factors may cause serious obstacles to STD prevention due to
their influence on social and sexual networks, access to and provision of care, willingness to seek care,
and social norms regarding sex and sexuality. Among certain vulnerable populations, historical
experience with segregation and discrimination exacerbates the influence of these factors. Social,
economic, and behavioral factors that affect the spread of STDs include:
 Racial and ethnic disparities. Certain racial and ethnic groups (mainly African American,
Hispanic, and American Indian/Alaska Native populations) have high rates of STDs, compared
with rates for whites.
 Poverty and marginalization. STDs disproportionately affect disenfranchised people and
people in social networks where high-risk sexual behavior is common, and either access to care
or health-seeking behavior is compromised.
 Access to health care. Access to high-quality health care is essential for early detection,
treatment, and behavior-change counseling for STDs. Groups with the highest rates of STDs are
often the same groups for whom access to or use of health services is most limited.
 Substance abuse. Many studies document the association of substance abuse with STDs. The
introduction of new illicit substances into communities often can alter sexual behavior
drastically in high-risk sexual networks, leading to the epidemic spread of STDs.
 Sexuality and secrecy. Perhaps the most important social factors contributing to the spread
of STDs in the United States are the stigma associated with STDs and the general discomfort of
discussing intimate aspects of life, especially those related to sex. These social factors separate
the United States from industrialized countries with low rates of STDs.
 Sexual networks. Sexual networks refer to groups of people who can be considered “linked”
by sequential or concurrent sexual partners. A person may have only 1 sex partner, but if that
partner is a member of a risky sexual network, then the person is at higher risk for STDs than a
similar individual from a nonrisky network.
–
116
Gonorrhea
Between 2008 and 2010, the annual average gonorrhea incidence rate was
57.2 cases per 100,000 population in San Bernadino County.
 Lower than the California incidence rate.
 Notably lower than the national incidence rate.
Gonorrhea Incidence
200
150
109.3
100
65.4
57.2
50
0
California
United States
Notes:
● Rates are annual average new cases per 100,000 population. US data is 2007-2009.
 Gonorrhea rates have decreased considerably in recent years across the
county, echoing the state trend. Nationally, the downward trend has been
less pronounced.
Gonorrhea Incidence
200
150
100
50
0
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
2008-2010
San Bernardino Co.
84.3
93.3
102.3
104.6
101.4
85.7
69.0
57.2
California
69.3
74.9
82.5
88.9
88.6
80.0
70.1
65.4
United States
121.7
117.2
114.8
115.9
117.4
116.1
109.3
Notes:
117
Syphilis
Between 2008 and 2010, the annual average primary/secondary syphilis
incidence rate was just 1.7 per 100,000 population in San Bernadino
County.
 Lower than the California incidence rate.
 Lower than the national incidence rate.
Primary/Secondary Syphilis Incidence
20
15
10
5.4
4.3
5
1.7
0
California
United States
Notes:
 However, syphilis incidence has increased across the county in recent years.
The state and nationwide rates increased steadily over the past decade as
well.
Primary/Secondary Syphilis Incidence
20
15
10
5
0
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
2008-2010
0.5
0.7
0.9
1.0
1.0
1.3
1.4
1.7
California
2.7
3.4
3.9
4.4
5.0
5.4
5.5
5.4
United States
2.3
2.5
2.7
3.0
3.3
3.8
4.3
Notes:
118
Chlamydia
Between 2008 and 2010, the annual average Chlamydia incidence rate was
404.3 cases per 100,000 population in the county.
 Comparable to the California incidence rate.
 Comparable to the national incidence rate.
Chlamydia Incidence
500
404.3
400
387.9
391.6
California
United States
300
200
100
0
Notes:
 Chlamydia incidence has increased across San Bernadino County since the
2001-2003 reporting period. State and national Chlamydia rates increased
steadily during this time as well.
Chlamydia Incidence
500
400
300
200
100
0
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
2008-2010
San Bernardino Co.
337.4
361.1
380.2
392.1
400.6
414.6
403.5
404.3
California
309.5
324.8
337.6
351.5
365.0
378.6
382.9
387.9
United States
289.4
304.4
317.8
331.1
347.1
370.0
391.6
Notes:
119
Acute Hepatitis B
Hepatitis B Incidence
Between 2007 and 2009, the hepatitis B rate across San Bernadino County
was 0.6 per 100,000 population.
 More favorable than the statewide rate.
Hepatitis B (Acute) Incidence
10
5
1.5
0.6
0.8
California
0
United States
Notes:
 San Bernadino County hepatitis B incidence has decreased in recent years,
echoing the downward trend reported both statewide and nationally.
Hepatitis B (Acute) Incidence
10
5
0
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
San Bernardino Co.
1.4
1.4
1.0
0.8
0.6
0.6
0.6
0.6
California
2.3
2.0
1.6
1.4
1.2
1.1
1.0
0.8
United States
2.8
2.9
2.7
2.5
2.2
1.8
1.6
1.5
Notes:
120
Hepatitis B Vaccination
Based on survey data, approximately 4 in 10 (39.5%) residents report
having received the hepatitis B vaccine.
 Similar to what is reported nationwide.
Have Ever Received the Hepatitis B Vaccination
100%
80%
60%
40%
39.2%
40.5%
Apple Valley
(PSA)
Hesperia
(PSA)
45.7%
35.8%
38.2%
Victorville
(PSA)
PSA
Overall
39.5%
38.4%
Total
Area
United
States
20%
0%
SSA
Overall
Notes:
 Note the negative correlation between age and hepatitis B vaccination.
 In addition, residents of “Other” races are more likely than Whites or
Hispanics to have received the hepatitis B vaccine.
Have Ever Received the Hepatitis B Vaccination
(Total Area, 2011)
100%
80%
60%
40%
51.8%
36.7%
51.6%
43.1%
42.1%
34.8%
33.6%
38.5%
39.5%
35.3%
19.7%
20%
0%
Men
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
Sources: ● 2010 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 84]
Notes:
121
Safe Sexual Practices
Sexual Partners
Among unmarried Total Area adults under 65, more than three-fourths cite
having only one (42.9%) or no (34.8%) sexual partners in the past 12
months.
Number of Sexual Partners in Past 12 Months
(Unmarried Respondents Aged 18-64, 2011)
Three/More 9.8%
Two 12.5%
None 34.8%
One 42.9%
Sources:
Notes:
 Asked of all unmarried respondents under the age of 65.
However, 9.8% report having three or more sexual partners in the past
year.
 Comparable to that reported nationally.
Had Three or More Sexual Partners in the Past Year
(Among Unmarried Respondents Aged 18 to 64; Total Area, 2011)
100%
80%
60%
40%
20%
9.8%
7.1%
0%
Total Area
United States
Notes:
● Asked of all unmarried respondents under the age of 65.
122
Condom Use
Among Total Area adults who are under age 65 and unmarried, 45.9%
report using a condom during their most recent sexual intercourse.
 Statistically similar to national findings.
Used Condom During Last Sexual Intercourse
(Among Unmarried Respondents Aged 18 to 64, 2011)
100%
80%
60%
45.9%
37.2%
40%
20%
0%
Total Area
United States
Notes:
● Asked of all unmarried respondents under the age of 65.
123
BIRTHS
124
Prenatal Care
Improving the well-being of mothers, infants, and children is an important public health goal for the
US. Their well-being determines the health of the next generation and can help predict future public
health challenges for families, communities, and the healthcare system. The risk of maternal and
infant mortality and pregnancy-related complications can be reduced by increasing access to quality
preconception (before pregnancy) and inter-conception (between pregnancies) care. Moreover,
healthy birth outcomes and early identification and treatment of health conditions among infants can
prevent death or disability and enable children to reach their full potential. Many factors can affect
pregnancy and childbirth, including pre-conception health status, age, access to appropriate
healthcare, and poverty.
Infant and child health are similarly influenced by socio-demographic factors, such as family income,
but are also linked to the physical and mental health of parents and caregivers. There are racial and
ethnic disparities in mortality and morbidity for mothers and children, particularly for African
Americans. These differences are likely the result of many factors, including social determinants (such
as racial and ethnic disparities in infant mortality; family income; educational attainment among
household members; and health insurance coverage) and physical determinants (i.e., the health,
nutrition, and behaviors of the mother during pregnancy and early childhood).
–
Early and continuous
prenatal care is the best
assurance of infant
health.
Between 2007 and 2009, 3.6% of all San Bernadino County births failed to
receive prenatal care before the third trimester of pregnancy (if they
received any at all).
 Less favorable than the California proportion.
Mothers Receiving Late Or No Prenatal Care
(Percentage of Live Births, 2007-2009)
50%
40%
30%
20%
10%
3.6%
3.2%
California
0%
Note:
● Numbers are a percentage of all live births within each population.
● Late prenatal care is defined as care started in the third trimester.
125
 This indicator has shown no clear increasing or decreasing trend over the
past several years.
Mothers Receiving Late Or No Prenatal Care
(Percentage of Live Births)
50%
40%
30%
20%
10%
0%
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
San Bernardino Co.
3.8%
3.4%
3.3%
3.2%
3.1%
3.3%
3.3%
3.6%
California
2.9%
2.7%
2.6%
2.6%
2.7%
2.9%
3.1%
3.2%
Note:
● Late prenatal care is defined as care started in the third trimester.
126
Birth Outcomes & Risks
Low birthweight babies,
those who weigh less than
2,500 grams (5 pounds,
8 ounces) at birth, are
much more prone to illness
and neonatal death than
are babies of normal
birthweight.
Largely a result of
receiving poor or
inadequate prenatal care,
many low-weight births
and the consequent
health problems are
preventable.
Low-Weight Births
A total of 7.2% of 2007-2009 San Bernadino County births were low-weight.
 Higher than the California proportion.
 Lower than the national proportion.
 Satisfies the Healthy People 2020 target (7.8% or lower).
Low-Weight Births
25%
20%
15%
10%
8.2%
7.2%
6.8%
California
5%
0%
Sources: ●
●
●
Note:
●
United States
Centers for Disease Control and Prevention, National Vital Statistics System.
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective MICH-8.1]
Numbers are a percentage of all live births within each population.
 The countywide proportion of low-weight births has increased slightly in
recent years; the proportion increased across California and the US during
the same time.
Low-Weight Births
25%
20%
15%
10%
5%
0%
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
Healthy People 2020
7.8%
7.8%
7.8%
7.8%
7.8%
7.8%
7.8%
7.8%
San Bernardino Co.
6.8%
6.8%
7.0%
7.1%
7.1%
7.1%
7.1%
7.2%
California
6.3%
6.4%
6.6%
6.7%
6.8%
6.9%
6.9%
6.8%
United States
7.7%
7.8%
7.9%
8.1%
8.2%
8.2%
8.2%
Sources: ●
●
●
Note:
●
Centers for Disease Control and Prevention, National Vital Statistics System.
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective MICH-8.1]
Numbers are a percentage of all live births within each population.
127
C-Sections
Between 2007 and 2009, 32.3% of live births in San Bernadino County were
delivered via c-section.
 Nearly identical to the California prevalence.
C-Section Births
100%
80%
60%
40%
32.3%
32.6%
31.7%
California
United States
20%
0%
● Centers for Disease Control and Prevention, National Vital Statistics System.
Note:
 The proportion of births delivered by c-section has increased steadily over
time across San Bernadino County; the proportion increased across California
and the US during the same time.
C-Section Births
100%
80%
60%
40%
20%
0%
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
San Bernardino Co.
25.3%
26.7%
28.1%
29.5%
30.8%
31.5%
31.8%
32.3%
California
25.1%
26.6%
28.0%
29.3%
30.4%
31.4%
32.0%
32.6%
United States
24.5%
26.0%
27.6%
29.0%
30.2%
31.1%
31.7%
Note:
128
Infant Mortality
Infant mortality rates
reflect deaths of children
less than one year old per
1,000 live births.
Between 2005 and 2007, there was an annual average of 6.6 infant deaths
per 1,000 live births.
 Less favorable than the California rate.
 Similar to the national rate.
 Fails to satisfy the Healthy People 2020 target of 6.0 per 1,000 live births.
Infant Mortality Rate
(2005-2007 Annual Average Infant Deaths per 1,000 Live Births)
25
20
15
10
6.9
6.6
5.3
5
0
California
United States
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective MICH-1.3]
Notes:
● Rates are three-year averages of deaths of children under 1 year old per 1,000 live births.
 The infant mortality rate is notably higher among births to mothers of
“Other” races.
(2005-2007 Annual Average Infant Deaths per 1,000 Live Births)
25
20
15
11.2
10
6.6
6.6
5.5
5
0
Non-Hispanic White
Hispanic
Non-Hispanic Other
Notes:
129
 Infant mortality rates have trended downward in recent years across San
Bernadino County, echoing the trends reported for California and the US
overall.
(Annual Average Infant Deaths per 1,000 Live Births)
25
20
15
10
5
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
Healthy People 2020
6.0
6.0
6.0
6.0
6.0
6.0
6.0
San Bernardino Co.
7.8
7.8
7.7
7.4
7.1
7.0
6.6
California
5.7
5.6
5.4
5.3
5.3
5.3
5.3
United States
7.2
7.0
6.9
6.9
6.9
6.9
6.9
Notes:
Risk Factors
Mothers With Low Educational Attainment
Between 2007 and 2009, 29.6% of births in the Total Area were to mothers
without a high school diploma.
 Less favorable than statewide proportion.
Births to Mothers Without a High School Diploma
100%
80%
60%
40%
29.6%
26.6%
20%
0%
California
Note:
130
 The prevalence of births to mothers with low educational attainment has
decreased in recent years across the county, echoing the California trend.
Births to Mothers Without a High School Diploma
100%
80%
60%
40%
20%
0%
2005-2007
2006-2008
2007-2009
San Bernardino Co.
33.8%
33.8%
29.6%
California
31.1%
30.7%
26.6%
Note:
131
Family Planning
Family planning is one of the 10 great public health achievements of the 20th century. The availability
of family planning services allows individuals to achieve desired birth spacing and family size and
contributes to improved health outcomes for infants, children, and women. Family planning services
include contraceptive and broader reproductive health services (patient education and counseling),
breast and pelvic examinations, breast and cervical cancer screening, sexually transmitted infection
(STI) and HIV prevention education/counseling/testing/referral, and pregnancy diagnosis and
counseling. For many women, a family planning clinic is their entry point into the healthcare system
and is considered to be their usual source of care. This is especially true for women with incomes
below the poverty level, women who are uninsured, Hispanic women, and Black women.
Unintended pregnancies (those reported by women as being mistimed or unwanted) are associated
with many negative health and economic outcomes. In 2001, almost one-half of all pregnancies in the
US were unintended. For women, negative outcomes associated with unintended pregnancy include:
 Delays in initiating prenatal care
 Reduced likelihood of breastfeeding
 Poor maternal mental health
 Lower mother-child relationship quality
 Increased risk of physical violence during pregnancy
Children born as a result of an unintended pregnancy are more likely to experience poor mental and
physical health during childhood and poor educational and behavioral outcomes.
–
The negative outcomes associated with unintended pregnancies are compounded for adolescents.
Teen mothers:
 Are less likely to graduate from high school or attain a GED by the time they reach age 30.
 Earn an average of approximately $3,500 less per year, when compared with those who delay
childbearing.
 Receive nearly twice as much Federal aid for nearly twice as long.
Similarly, early fatherhood is associated with lower educational attainment and lower income.
Children of teen parents are more likely to have lower cognitive attainment and exhibit more
behavior problems. Sons of teen mothers are more likely to be incarcerated, and daughters are more
likely to become adolescent mothers.
–
A total of 12.4% of 2007-2009 Total Area births were to teenage mothers
under the age of 20.
 Higher than the California proportion.
 Higher than the national proportion.
132
100%
80%
60%
40%
20%
12.4%
9.3%
10.4%
California
United States
0%
Note:
 This percentage has remained fairly stable over the past decade in San
Bernadino County; the percentage decreased slightly both statewide and
nationwide.
100%
80%
60%
40%
20%
0%
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
San Bernardino Co.
13.0%
12.5%
12.0%
12.0%
12.0%
12.2%
12.4%
12.4%
California
10.0%
9.5%
9.2%
9.1%
9.2%
9.3%
9.4%
9.3%
United States
11.3%
10.8%
10.4%
10.3%
10.3%
10.4%
10.4%
Note:
133
MODIFIABLE
HEALTH RISKS
134
Actual Causes Of Death
A 1999 study (an update to a landmark 1993 study), estimated that as many as 40% of premature
deaths in the United States are attributed to behavioral factors. This study found that behavior
patterns represent the single-most prominent domain of influence over health prospects in the United
States. The daily choices we make with respect to diet, physical activity, and sex; the substance abuse
and addictions to which we fall prey; our approach to safety; and our coping strategies in confronting
stress are all important determinants of health.
The most prominent contributors to mortality in the United States in 2000 were tobacco (an estimated
435,000 deaths), diet and activity patterns (400,000), alcohol (85,000), microbial agents (75,000), toxic
agents (55,000), motor vehicles (43,000), firearms (29,000), sexual behavior (20,000), and illicit use of
drugs (17,000). Socioeconomic status and access to medical care are also important contributors, but
difficult to quantify independent of the other factors cited. Because the studies reviewed used
different approaches to derive estimates, the stated numbers should be viewed as first
approximations.
These analyses show that smoking remains the leading cause of mortality. However, poor diet and
physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along
with escalating healthcare costs and aging population, argue persuasively that the need to establish a
more preventive orientation in the US healthcare and public health systems has become more urgent.
–
While causes of death are
typically described as the
diseases or injuries
immediately precipitating
the end of life, a few
important studies have
shown that the actual
causes of premature death
(reflecting underlying risk
factors) are often
preventable.
Ali H. Mokdad, PhD; James S. Marks, MD, MPH; Donna F. Stroup, Phd, MSc; Julie L. Gerberding, MD, MPH. “Actual Causes of
Death in the United States.” JAMA, 291(2004):1238-1245.
Cardiovascular disease
Cancer
Cerebrovascular disease
Accidental injuries
Chronic lung disease
Underlying Risk Factors (Actual Causes of Death)
Tobacco use
Obesity
Elevated serum cholesterol
Diabetes
High blood pressure
Sedentary lifestyle
Tobacco use
Alcohol
Improper diet
Occupational/environmental exposures
High blood pressure
Elevated serum cholesterol
Tobacco use
Safety belt noncompliance
Occupational hazards
Alcohol/substance abuse
Stress/fatigue
Reckless driving
Tobacco use
Occupational/environmental exposures
Source: National Center for Health Statistics/US Department of Health and Human Services, Health United States: 1987.
DHHS Pub. No. (PHS) 88–1232.
Factors Contributing to
Premature Deaths in the United States
Medical Care
10%
Social
Circumstances
15%
Genetics
30%
Physical
Environment
5%
Lifestyle/
Behaviors
40%
Tobacco
18%
Diet/Inactivity
17%
Alcohol
4%
Infectious Disease
3%
Toxic Agents
2%
Motor Vehicle
2%
Firearms
1%
Sexual Behavior
1%
Illicit Drugs
1%
Other
52%
Sources: “The Case For More Active Policy Attention to Health Promotion”; (McGinnis, Williams-Russo, Knickman) Health Affairs, Vol. 21, No. 2, March/April 2002.
“Actual Causes of Death in the United States”; (Ali H. Mokdad, PhD; James S. Marks, MD, MPH; Donna F. Stroup, Phd, MSc; Julie L. Gerberding, MD, MPH)
JAMA, 291(2000):1238-1245.
135
Nutrition
Strong science exists supporting the health benefits of eating a healthful diet and maintaining a
healthy body weight. Efforts to change diet and weight should address individual behaviors, as well as
the policies and environments that support these behaviors in settings such as schools, worksites,
healthcare organizations, and communities.
The goal of promoting healthful diets and healthy weight encompasses increasing household food
security and eliminating hunger.
Americans with a healthful diet:
 Consume a variety of nutrient-dense foods within and across the food groups, especially whole
grains, fruits, vegetables, low-fat or fat-free milk or milk products, and lean meats and other
protein sources.
 Limit the intake of saturated and trans fats, cholesterol, added sugars, sodium (salt), and
alcohol.
 Limit caloric intake to meet caloric needs.
Diet and body weight are related to health status. Good nutrition is important to the growth and
development of children. A healthful diet also helps Americans reduce their risks for many health
conditions, including: overweight and obesity; malnutrition; iron-deficiency anemia; heart disease;
high blood pressure; dyslipidemia (poor lipid profiles); type 2 diabetes; osteoporosis; oral disease;
constipation; diverticular disease; and some cancers.
Diet reflects the variety of foods and beverages consumed over time and in settings such as worksites,
schools, restaurants, and the home. Interventions to support a healthier diet can help ensure that:
 Individuals have the knowledge and skills to make healthier choices.
 Healthier options are available and affordable.
Social Determinants of Diet. Demographic characteristics of those with a more healthful diet vary
with the nutrient or food studied. However, most Americans need to improve some aspect of their
diet.
Social factors thought to influence diet include:
 Knowledge and attitudes
 Skills
 Social support
 Societal and cultural norms
 Food and agricultural policies
 Food assistance programs
 Economic price systems
Physical Determinants of Diet. Access to and availability of healthier foods can help people follow
healthful diets. For example, better access to retail venues that sell healthier options may have a
positive impact on a person's diet; these venues may be less available in low-income or rural
neighborhoods.
The places where people eat appear to influence their diet. For example, foods eaten away from
home often have more calories and are of lower nutritional quality than foods prepared at home.
Marketing also influences people's—particularly children's—food choices.
–
136
Daily Recommendation of Fruits/Vegetables
To measure fruit and
vegetable consumption,
survey respondents were
asked multiple questions,
specifically about the foods
and drinks they consumed
on the day prior to the
interview.
A total of 38.9% of Total Area adults report eating five or more servings of
fruits and/or vegetables per day.
No significant difference by service area.
Within the Primary Service Area, no difference to report.
Consume 5+ Servings of Fruits/Vegetables Per Day
100%
80%
60%
48.8%
45.5%
40.5%
35.7%
40%
40.2%
33.2%
38.9%
20%
0%
Apple Valley
(PSA)
Sources: ●
●
Notes:
●
●
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
For this issue, respondents were asked to recall their food intake on the previous day.
 Area Hispanics are less likely to get the recommended servings of daily
fruits/vegetables.
Consume 5+ Servings of Fruits/Vegetables Per Day
(Total Area, 2011)
100%
80%
60%
40%
51.6%
38.9%
39.0%
43.6%
40.4%
34.8%
34.8%
39.6%
41.4%
38.9%
29.2%
20%
0%
Men
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
Notes:
● For this issue, respondents were asked to recall their food intake on the previous day.
137
Fruits
The majority (57.9%) of Total Area adults reports eating at least two
servings of fruit per day.
Vegetables
A total of 34.2% of survey respondents reports eating three or more
servings of vegetables per day, at least one-third of which are dark green
or orange vegetables.
Significantly higher (more favorable) in the Primary Service Area than in the
Fruits/Vegetable Consumption
(Total Area, 2011)
Yes
34.2%
No
42.1%
US=40.1%
Yes
57.9%
US=60.5%
Consume 2+ Servings of
Fruits/Fruit Juices Per Day
Sources:
Notes:
No
65.8%
Consume 3+ Servings of Vegetables Per Day,
One-Third of Which Are Dark Green or Orange
● Professional Research Consultants, Inc. PRC Community Health Survey. [Items 176-177]
138
Health Advice About Diet & Nutrition
A total of 48.3% of survey respondents acknowledge that a physician
counseled them about diet and nutrition in the past year.
 Higher than national findings.
Statistically similar by service area (and by community within the Primary
Service Area); not shown.
 Note: Among obese respondents, 59.2% report receiving diet/nutrition
advice (meaning that nearly 4 in 10 did not).
Have Received Advice About Diet and Nutrition in the
Past Year From a Physician, Nurse, or Other Health Professional
(By Weight Classification)
100%
80%
60%
53.6%
59.2%
48.3%
41.9%
40%
29.9%
20%
0%
Total Area:
Healthy Weight
Sources:
Notes:
Total Area:
Overwt/Not Obese
Total Area:
Obese
Total Area:
All Adults
United States:
All Adults
● Professional Research Consultants, Inc. PRC Community Health Survey. [Item 18]
139
Physical Activity
Regular physical activity can improve the health and quality of life of Americans of all ages, regardless
of the presence of a chronic disease or disability. Among adults and older adults, physical activity can
lower the risk of: early death; coronary heart disease; stroke; high blood pressure; type 2 diabetes;
breast and colon cancer; falls; and depression. Among children and adolescents, physical activity can:
improve bone health; improve cardiorespiratory and muscular fitness; decrease levels of body fat; and
reduce symptoms of depression. For people who are inactive, even small increases in physical activity
are associated with health benefits.
Personal, social, economic, and environmental factors all play a role in physical activity levels among
youth, adults, and older adults. Understanding the barriers to and facilitators of physical activity is
important to ensure the effectiveness of interventions and other actions to improve levels of physical
activity.
Factors positively associated with adult physical activity include: postsecondary education; higher
income; enjoyment of exercise; expectation of benefits; belief in ability to exercise (self-efficacy);
history of activity in adulthood; social support from peers, family, or spouse; access to and satisfaction
with facilities; enjoyable scenery; and safe neighborhoods.
Factors negatively associated with adult physical activity include: advancing age; low income; lack of
time; low motivation; rural residency; perception of great effort needed for exercise; overweight or
obesity; perception of poor health; and being disabled. Older adults may have additional factors that
keep them from being physically active, including lack of social support, lack of transportation to
facilities, fear of injury, and cost of programs.
Among children ages 4 to 12, the following factors have a positive association with physical activity:
 Gender (boys)
 Belief in ability to be active (self-efficacy)
 Parental support
Among adolescents ages 13 to 18, the following factors have a positive association with physical
activity:
 Parental education
 Gender (boys)
 Personal goals
 Physical education/school sports
 Belief in ability to be active (self-efficacy)
 Support of friends and family
Environmental influences positively associated with physical activity among children and adolescents
include:
 Presence of sidewalks
 Having a destination/walking to a particular place
 Access to public transportation
 Low traffic density
 Access to neighborhood or school play area and/or recreational equipment
People with disabilities may be less likely to participate in physical activity due to physical, emotional,
and psychological barriers. Barriers may include the inaccessibility of facilities and the lack of staff
trained in working with people with disabilities.
–
140
Level of Activity at Work
A majority of employed respondents reports low levels of physical activity
at work.
 Just over 1 in 2 (54.6%) employed respondents report that their job entails
mostly sitting or standing, similar to the US figure.
 24.2% report that their job entails mostly walking (similar to that reported
nationally).
 21.2% report that their work is physically demanding (higher than reported
nationally).
Primary Level of Physical Activity At Work
(Among Employed Respondents)
100%
Total Area
United States
80%
63.2%
60%
54.6%
40%
24.2%
22.2%
21.2%
14.6%
20%
0%
Sitting/Standing
Sources:
Notes:
Mostly Walking
Physically Demanding
● Asked of those respondents who are employed for wages.
141
Leisure-Time Physical Activity
A total of 24.0% of Total Area adults report no leisure-time physical activity
in the past month.
 Satisfies the Healthy People 2020 objective (32.6% or lower).
No Leisure-Time Physical Activity in the Past Month
100%
80%
60%
40%
22.9%
22.1%
Apple Valley
(PSA)
Hesperia
(PSA)
26.9%
28.7%
24.3%
22.9%
24.0%
22.1%
PSA
Overall
SSA
Overall
Total
Area
California
20%
0%
Victorville
(PSA)
United
States
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective PA-1]
Notes:
Lack of leisure-time physical activity in the area is higher among:
 Adults aged 40 and older (note the positive correlation with age).
 Lower-income residents.
No Leisure-Time Physical Activity in the Past Month
(Total Area, 2011)
100%
80%
60%
42.6%
40%
22.6%
31.6%
28.0%
25.4%
14.8%
20%
30.5%
19.9%
21.2%
200%+
FPL
White
24.0%
18.3%
0%
Men
Sources:
Notes:
●
●
●
●
Women
18 to 39
40 to 64
65+
<200%
FPL
Hispanic
Other
Total
Area
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective PA-1]
142
Activity Levels
This report uses the following definition for physical activity recommendations:

Moderate-intensity physical activities (inducing only light sweating or a slight to moderate
increase in breathing or heart rate) for at least 30 minutes on 5 or more days of the week.

Vigorous-intensity physical activity (inducing heavy sweating or a large increase in
breathing or heart rate) 3 or more days per week for 20 or more minutes per occasion.
OR
Recommended Levels of Physical Activity
A total of 45.4% of Total Area adults participate in regular, sustained
moderate or vigorous physical activity (meeting physical activity
recommendations).
 Less favorable than statewide findings.
Meets Physical Activity Recommendations
100%
80%
60%
43.4%
41.5%
Apple Valley
(PSA)
Hesperia
(PSA)
50.9%
46.6%
44.1%
Victorville
(PSA)
PSA
Overall
45.4%
51.3%
42.7%
40%
20%
0%
Sources:
Notes:
SSA
Overall
Total
Area
California
United
States
● In this case the term “meets physical activity recommendations” refers to participation in moderate physical activity (exercise that produces only light sweating
or a slight to moderate increase in breathing or heart rate ) at least 5 times a week for 30 minutes at a time, and/or vigorous physical activity (activities that
cause heavy sweating or large increases in breathing or heart rate) at least 3 times a week for 20 minutes at a time.
143
 Adults aged 40 and older are less likely to meet physical activity
requirements.
Meets Physical Activity Recommendations
(Total Area, 2011)
100%
80%
60%
53.6%
53.1%
49.1%
41.8%
40.8%
40%
45.3%
45.0%
44.0%
42.6%
<200%
FPL
200%+
FPL
White
Hispanic
45.4%
33.6%
20%
0%
Men
Sources:
Notes:
●
●
●
●
Women
18 to 39
40 to 64
65+
Other
Total
Area
FPL = Federal Poverty Level based on household income and number of household members [US Department of Health & Human Services poverty guidelines].
In this case the term “meets physical activity recommendations” refers to participation in moderate physical activity (exercise that produces only light sweating
or a slight to moderate increase in breathing or heart rate ) at least 5 times a week for 30 minutes at a time, and/or vigorous physical activity (activities that
cause heavy sweating or large increases in breathing or heart rate) at least 3 times a week for 20 minutes at a time.
Moderate & Vigorous Physical Activity
The individual indicators
of moderate physical
activity, vigorous physical
activity, and strengthening
activities are shown here.
In the past month:
A total of 28.8% of adults participated in moderate physical activity (5 times
a week, 30 minutes at a time).
 Similar to the national level.
A total of 34.8% participated in vigorous physical activity (3 times a week, 20
minutes at a time).
 Similar to the prevalence reported statewide.
 Identical to the nationwide figure.
144
Moderate & Vigorous Physical Activity
(Total Area, 2011)
Yes
28.8%
No
71.2%
Yes
34.8%
No
65.2%
US=23.9%
Moderate Physical Activity
US=34.8%
Vigorous Physical Activity
Sources: ●
●
Notes:
●
●
Professional Research Consultants, Inc. PRC Community Health Survey. [Items 180-181]
Moderate Physical Activity: Takes part in exercise that produces only light sweating or a slight to moderate increase in breathing or heart rate at least 5 times per week
for at least 30 minutes per time.
● Vigorous Physical Activity: Takes part in activities that cause heavy sweating or large increases in breathing or heart rate at least 3 times per week for at least
20 minutes per time.
Health Advice About Physical Activity & Exercise
A total of one-half (49.9%) of Total Area adults reports that their physician
has asked about or given advice to them about physical activity in the past
year.
 Similar to the national average.
 Note: 61.9% of obese Total Area respondents say that they have talked with
their doctor about physical activity/exercise in the past year.
Have Received Advice About Exercise in the
Past Year From a Physician, Nurse, or Other Health Professional
100%
80%
61.9%
60%
40%
51.0%
49.9%
47.8%
Total Area:
All Adults
United States:
All Adults
36.4%
20%
0%
Total Area:
Healthy Weight
Sources:
Notes:
Total Area:
Overwt/Not Obese
Total Area:
Obese
145
Children’s Screen Time
The following charts outline parents' reports of the amount of time their children
spend watching TV and using other screen time (video games, computer or
Internet entertainment) on an average weekday. Note:
 46.2% spend one hour or less watching television on an average weekday.
 76.1% spend one hour or less on other screen time on an average weekday.
Childrens Screen Time
(Among Parents of Children Ages 2-17; Overall, 2011)
Two Hours
35.0%
Two Hours
9.9%
Three or
More Hours
18.8%
Three or
More Hours
14.0%
One Hour
34.5%
None 8.1%
None 25.0%
One Hour
29.4%
Less Than
One 8.7%
Less Than
One 16.6%
Number of Hours/Day of Television
Sources:
Notes:
Number of Hours/Day of Other Screen Time
(i.e., video games and computer/Internet entertainment)
 Professional Research Consultants, Inc. PRC Community Health Survey [Items 145-146]
 Asked of respondents with a child aged 2 to 17 in the household.
However, altogether, 45.7% of school-aged children (5-17) spend 3+ hours
on combined screen time for entertainment daily (tv and other screen sources
together).
 Similar to what is found nationally.
 This is notably higher (55.3%) among Total Area teens.
Childrens Total Screen Time Per School Day:
3+ Hours of TV, Computer, Video Games, Etc. for Entertainment
(Total Area Parents of Children 5-17, 2011)
100%
80%
55.3%
60%
40%
45.7%
43.4%
Total Area Children 5-17
US Children 5-17
39.4%
20%
0%
Total Area Teens 13-17
Notes:
● Asked of all respondents with children 5-17 at home.
● For this issue, respondents with children who are not in school referred to “weekdays” while parents of children in school referred to typical school days.
● “3+ hours” includes reported television watching of 180 minutes or more per school day.
146
Weight Status
Because weight is influenced by energy (calories) consumed and expended, interventions to improve
weight can support changes in diet or physical activity. They can help change individuals' knowledge
and skills, reduce exposure to foods low in nutritional value and high in calories, or increase
opportunities for physical activity. Interventions can help prevent unhealthy weight gain or facilitate
weight loss among obese people. They can be delivered in multiple settings, including healthcare
settings, worksites, or schools.
The social and physical factors affecting diet and physical activity (see Physical Activity topic area) may
also have an impact on weight. Obesity is a problem throughout the population. However, among
adults, the prevalence is highest for middle-aged people and for non-Hispanic black and Mexican
American women. Among children and adolescents, the prevalence of obesity is highest among older
and Mexican American children and non-Hispanic black girls. The association of income with obesity
varies by age, gender, and race/ethnicity.
–
Body Mass Index (BMI), which describes relative weight for height, is significantly correlated with total
body fat content. The BMI should be used to assess overweight and obesity and to monitor changes in
body weight. In addition, measurements of body weight alone can be used to determine efficacy of
weight loss therapy. BMI is calculated as weight (kg)/height squared (m2). To estimate BMI using
pounds and inches, use: [weight (pounds)/height squared (inches2)] x 703.
In this report, overweight is defined as a BMI of 25.0 to 29.9 kg/m2 and obesity as a BMI of 30 kg/m2.
The rationale behind these definitions is based on epidemiological data that show increases in
mortality with BMIs above 25 kg/m2. The increase in mortality, however, tends to be modest until a
BMI of 30 kg/m2 is reached. For persons with a BMI of 30 kg/m2, mortality rates from all causes, and
especially from cardiovascular disease, are generally increased by 50 to 100 percent above that of
persons with BMIs in the range of 20 to 25 kg/m2.
–
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report.
National Institutes of Health. National Heart, Lung, and Blood Institute in Cooperation With The National Institute of Diabetes
and Digestive and Kidney Diseases. September 1998.
Classification of Overweight and Obesity by BMI
BMI (kg/m2)
Underweight
<18.5
Normal
18.5 – 24.9
Overweight
25.0 – 29.9
Obese
≥30.0
Source: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults:
The Evidence Report. National Institutes of Health. National Heart, Lung, and Blood Institute in
Cooperation With The National Institute of Diabetes and Digestive and Kidney Diseases. September 1998.
Adult Weight Status
Self-Perceived Weight
When asked to evaluate their own body weight, one-third (33.3%) of Total
Area adults considers themselves to be “about right.”
 While 6.3% consider themselves to be underweight, 44.2% feel they are
“somewhat overweight” and 16.2% consider themselves to be “very
overweight.”
147
Self-Perceived Body Weight
(Total Area, 2011)
Very Overweight
16.2%
Underweight 6.3%
About Right 33.3%
Somewhat
Overweight 44.2%
Sources:
Notes:
 The prevalence of adults who considers him/herself to be overweight is
60.0% among overweight adults (based on self-reported BMI) and 93.6%
among obese residents.
Consider Self to be Overweight
(By Weight Classification; Total Area, 2011)
100%
93.6%
80%
60%
60.4%
60.0%
40%
20%
22.6%
0%
Healthy Weight
Sources:
Notes:
Overweight/Not Obese
Obese
Total Sample
● Based on reported heights and weights, asked of all respondents.
● The definition of overweight is having a body mass index (BMI), a ratio of weight to height (kilograms divided by meters squared), greater than or equal to 25.0,
regardless of gender. The definition for obesity is a BMI greater than or equal to 30.0.
Healthy Weight
“Healthy weight “means
neither underweight,
nor overweight
(BMI = 18.5-24.9).
Based on self-reported heights and weights, 30.7% of Total Area adults are
at a healthy weight.
148
Healthy Weight
(Body Mass Index Between 18.5-24.9)
100%
80%
60%
40%
31.6%
30.3%
34.2%
32.3%
30.7%
31.7%
Total
Area
United
States
23.4%
20%
0%
Apple Valley
(PSA)
Sources:
Notes:
●
●
●
●
●
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective NWS-8]
Based on reported heights and weights, asked of all respondents.
The definition of healthy weight is having a body mass index (BMI), a ratio of weight to height (kilograms divided by meters squared), between 18.5 and 24.9.
Overweight Status
Here, “overweight“
includes those respondents
with a BMI value ≥25.
A total of 68.4% of Total Area residents are overweight.
 Less favorable than the California prevalence.
 Statistically similar to the US overweight prevalence.
Prevalence of Total Overweight
(Overweight or/Obese Adults; Body Mass Index of 25.0 or Higher)
100%
76.0%
80%
68.6%
68.4%
64.0%
68.4%
66.7%
61.3%
66.9%
60%
40%
20%
0%
Apple Valley
(PSA)
Sources:
Notes:
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
California
United
States
● The definition of overweight is having a body mass index (BMI), a ratio of weight to height (kilograms divided by meters squared), greater than or equal to 25.0,
regardless of gender. The definition for obesity is a BMI greater than or equal to 30.0.
149
“Obese“ (also included in
overweight prevalence
discussed previously)
includes respondents
with a BMI value ≥30.
Specifically, one-third (33.7%) of Total Area adults is obese.
 Less favorable than California findings.
 Similar to US findings.
 Similar to the Healthy People 2020 target (30.6% or lower).
Within the Primary Service Area, higher (less favorable) in Apple Valley.
Prevalence of Obesity
(Body Mass Index of 30.0 or Higher)
100%
80%
60%
44.3%
40%
29.2%
34.2%
35.1%
27.8%
33.7%
28.5%
25.5%
20%
0%
Apple Valley
(PSA)
Sources:
Notes:
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
California
United
States
●
●
●
●
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human Services,
● The definition of obesity is having a body mass index (BMI), a ratio of weight to height (kilograms divided by meters squared), greater than or equal to 30.0,
regardless of gender.
 No significant difference in obesity prevalence when viewed by demographic
characteristic.
Prevalence of Obesity
(Body Mass Index of 30.0 or Higher; Total Area, 2011)
100%
80%
60%
34.6%
40%
38.0%
32.8%
32.1%
Women
18 to 39
36.4%
35.4%
39.4%
36.3%
29.5%
33.7%
28.9%
20%
0%
Men
Sources:
Notes:
●
●
●
●
●
●
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
Based on reported heights and weights, asked of all respondents.
The definition of obesity is having a body mass index (BMI), a ratio of weight to height (kilograms divided by meters squared), greater than or equal to 30.0,
regardless of gender.
150
Relationship of Overweight With Other Health Issues
Overweight and obese adults are more likely to report a number of adverse
health conditions.
Among these are:
 Hypertension (high blood pressure).
 High cholesterol.
 Nasal/hay fever allergies.
 Chronic depression.
 Activity limitations.
 “Fair” or “poor” physical health.
 Diabetes.
 Asthma.
 Skin Cancer.
Relationship of Overweight With Other Health Issues
(Total Area; By Weight Classification)
100%
Healthy Weight
Overweight/Not Obese
Obese
12.1%
5.5%
3.6%
19.5%
15.9%
10.0%
22.9%
9.5%
10.5%
30.5%
17.7%
33.4%
20.5%
19.0%
37.0%
30.0%
25.3%
42.9%
43.2%
23.7%
14.6%
20%
17.3%
40%
18.6%
37.5%
60%
31.3%
54.2%
80%
16.3%
The correlation
between overweight
and various health
issues cannot be
disputed.
0%
High
Blood
Pressure
Sources:
Notes:
High
Nasal/Hay
Cholesterol Fever Allergies
Chronic
Depression
Activity
Limitations
"Fair/Poor"
Health
Diabetes
Asthma
Skin
Cancer
● Professional Research Consultants, Inc. PRC Community Health Survey. [Items 5, 28, 35, 48, 51, 120, 123, 149, 150]
151
Weight Management
Health Advice
One-fourth (25.5%) of adults have been given advice about their weight by
a doctor, nurse or other health professional in the past year.
 Statistically similar to the national findings.
 Note that 40.9% of obese adults have been given advice about their weight
by a health professional in the past year (while 6 in 10 have not).
-
Satisfies the Healthy People 2020 target of 31.8% or higher.
Have Received Advice About Weight in the Past Year
From a Physician, Nurse, or Other Health Professional
Healthy People 2020 Target = 31.8% or Higher for Obese Adults
100%
80%
60%
40.9%
40%
24.9%
25.5%
25.7%
Total Area:
All Adults
United States:
All Adults
20%
6.6%
0%
Total Area:
Healthy Weight
Sources:
Notes:
●
●
●
●
Total Area:
Overwt/Not Obese
Total Area:
Obese
Professional Research Consultants, Inc. PRC Community Health Survey. [Items 117, 188-189]
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective NWS-6.2]
152
Weight Control
Individuals who are at a healthy weight are less likely to:
 Develop chronic disease risk factors, such as high blood pressure and dyslipidemia.
 Develop chronic diseases, such as type 2 diabetes, heart disease, osteoarthritis, and some
cancers.
 Experience complications during pregnancy.
 Die at an earlier age.
All Americans should avoid unhealthy weight gain, and those whose weight is too high may also need
to lose weight.
–
A total of 43.9% of Total Area adults who are overweight say that they are
both modifying their diet and increasing their physical activity to try to
lose weight.
 Note: 38.6% of obese Total Area adults report that they are trying to lose
weight through a combination of diet and exercise, similar to what is found
nationally.
Trying to Lose Weight by Both
Modifying Diet and Increasing Physical Activity
100%
Overweight/Obese
Obese
80%
60%
48.1%
43.9%
41.1%
38.6%
40%
20%
0%
Total Area
Sources:
Notes:
United States
153
Childhood Overweight & Obesity
In children and teens, body mass index (BMI) is used to assess weight status – underweight, healthy
weight, overweight, or obese. After BMI is calculated for children and teens, the BMI number is
plotted on the CDC BMI-for-age growth charts (for either girls or boys) to obtain a percentile ranking.
Percentiles are the most commonly used indicator to assess the size and growth patterns of individual
children in the United States. The percentile indicates the relative position of the child's BMI number
among children of the same sex and age.
BMI-for-age weight status categories and the corresponding percentiles are shown below:
–

Underweight
<5th percentile

Healthy Weight
≥5th and <85th percentile

Overweight
≥85th and <95th percentile

Obese
≥95th percentile
Centers for Disease Control and Prevention.
Perception of Child’s Weight
When asked to describe their childs weight, 70.9% of parents with children
aged 2-17 consider their childs weight to be “about right.”

In contrast, 14.2% of parents consider their child to be underweight, while
12.7% gave “somewhat overweight” opinions of their child's weight and
2.2% consider their child to be “very overweight.”
Childs Weight as Described by Parent
(Total Area Parents of Children 2-17, 2011)
Obese 2.2%
Overweight 12.7%
Underweight 14.2%
Healthy Weight
70.9%
Sources:
Notes:
● Asked of all respondents with children aged 2-17.
 This distribution is similar to what is found nationally.
154
Child’s Weight Status
Based on the heights/weights reported by surveyed parents, 31.2% of Total
th
Area children age 6 to 17 are overweight or obese (≥85 percentile).

Similar to that found nationally.
Child Total Overweight Prevalence
(Percent of Children 6-17 Who Are Overweight/Obese;
Body Mass Index in the 85th Percentile or Higher)
100%
80%
60%
40%
31.2%
30.7%
Total Area
United States
20%
0%
Sources: ●
●
Notes:
●
●
Asked of all respondents with children aged 6-17 at home.
Overweight among children is estimated based on childrens Body Mass Index status at or above the 85th percentile of US growth charts by gender and age.
Specifically, 16.0% of Total Area children age 6 to 17 are obese
th
(≥95 percentile).

Similar to the national percentage.

Similar to the Healthy People 2020 target (14.6% or lower for children age 219).
Child Obesity Prevalence
(Percent of Children 6-17 Who Are Obese;
Body Mass Index in the 95th Percentile or Higher)
100%
80%
60%
40%
20%
16.0%
18.9%
0%
Total Area
Sources: ●
●
●
Notes:
●
●
United States
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective NWS-10.4]
Asked of all respondents with children aged 6-17 at home.
Obesity among children is estimated based on childrens Body Mass Index status equal to or above the 95th percentile of US growth charts by gender and age.
155
A total of 4.9% of parents with children aged 2-17 have been told by a
health professional that their child is overweight.
 Statistically similar to the US figure.
 The Total Area prevalence is twice as high among children who are
overweight/obese.
Have Been Told That Child is Overweight
(By Weight Classification; Total Area Parents of Children 2-17, 2011)
100%
80%
60%
40%
20%
10.3%
10.7%
4.9%
3.2%
US Children 2-17
0%
Overweight Children 5-17
Sources:
Notes:
●
●
●
●
Obese Children 5-17
Based on reported heights and weights, asked of all respondents with children aged 2-17.
Overweight among children is estimated based on childrens Body Mass Index status at or above the 85th percentile of US growth charts by gender and age.
Obesity among children is estimated based on childrens Body Mass Index status equal to or above the 95th percentile of US growth charts by gender and age.
156
Substance Abuse
In 2005, an estimated 22 million Americans struggled with a drug or alcohol problem. Almost 95% of
people with substance use problems are considered unaware of their problem. Of those who
recognize their problem, 273,000 have made an unsuccessful effort to obtain treatment. These
estimates highlight the importance of increasing prevention efforts and improving access to
treatment for substance abuse and co-occurring disorders.
Substance abuse has a major impact on individuals, families, and communities. The effects of
substance abuse are cumulative, significantly contributing to costly social, physical, mental, and public
health problems. These problems include:
 Teenage pregnancy
 Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)
 Other sexually transmitted diseases (STDs)
 Domestic violence
 Child abuse
 Motor vehicle crashes
 Physical fights
 Crime
 Homicide
 Suicide
The field has made progress in addressing substance abuse, particularly among youth. According to
data from the national Institute of Drug Abuse (NIDA) Monitoring the Future (MTF) survey, which is
an ongoing study of the behaviors and values of America's youth between 2004 and 2009, a drop in
drug use (including amphetamines, methamphetamine, cocaine, hallucinogens, and LSD) was reported
among students in 8th, 10th, and 12th grades. Note that, despite a decreasing trend in marijuana use
which began in the mid-1990s, the trend has stalled in recent years among these youth. Use of
alcohol among students in these three grades also decreased during this time.
Substance abuse refers to a set of related conditions associated with the consumption of mind- and
behavior-altering substances that have negative behavioral and health outcomes. Social attitudes and
political and legal responses to the consumption of alcohol and illicit drugs make substance abuse one
of the most complex public health issues. In addition to the considerable health implications,
substance abuse has been a flash-point in the criminal justice system and a major focal point in
discussions about social values: people argue over whether substance abuse is a disease with genetic
and biological foundations or a matter of personal choice.
Advances in research have led to the development of evidence-based strategies to effectively address
substance abuse. Improvements in brain-imaging technologies and the development of medications
that assist in treatment have gradually shifted the research community's perspective on substance
abuse. There is now a deeper understanding of substance abuse as a disorder that develops in
adolescence and, for some individuals, will develop into a chronic illness that will require lifelong
monitoring and care.
Improved evaluation of community-level prevention has enhanced researchers' understanding of
environmental and social factors that contribute to the initiation and abuse of alcohol and illicit
drugs, leading to a more sophisticated understanding of how to implement evidence-based strategies
in specific social and cultural settings.
A stronger emphasis on evaluation has expanded evidence-based practices for drug and alcohol
treatment. Improvements have focused on the development of better clinical interventions through
research and increasing the skills and qualifications of treatment providers.
–
157
Age-Adjusted Cirrhosis/Liver Disease Deaths
cirrhosis/liver disease mortality rate of 13.7 deaths per 100,000 population
Cirrhosis/Liver Disease: Age-Adjusted Mortality
25
20
13.7
15
11.1
9.0
10
5
0
California
United States
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective SA-11]
Notes:
 Cirrhosis mortality rates are much higher among Hispanics in San Bernadino
County.
Cirrhosis/Liver Disease: Age-Adjusted Mortality by Race
100
80
60
40
20
14.0
17.5
13.7
7.2
0
Non-Hispanic White
Hispanic
Non-Hispanic Other
Notes:
158
 Mortality rates have not changed significantly across San Bernadino County
over the past decade. Statewide and nationwide, rates have decreased
slightly.
Cirrhosis/Liver Disease: Age-Adjusted Mortality Trends
25
20
15
10
5
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
Healthy People 2020
8.2
8.2
8.2
8.2
8.2
8.2
2005-2007
8.2
San Bernardino Co.
13.5
14.8
14.9
14.7
13.3
13.1
13.7
California
11.9
11.8
11.6
11.4
11.2
11.0
11.1
United States
9.5
9.5
9.4
9.2
9.1
8.9
9.0
Notes:
Chronic drinkers
include survey
respondents reporting
60 or more drinks of
alcohol in the month
preceding the
interview. For the
purposes of this study,
a “drink” is considered
one can or bottle of
beer, one glass of
wine, one can or bottle
of wine cooler, one
cocktail, or one shot of
liquor.
High-Risk Alcohol Use
Chronic Drinking
A total of 5.6% of area adults averaged two or more drinks of alcohol per
day in the past month (chronic drinkers).
 Similar to the statewide proportion.
 Similar to the national proportion.
Significantly lower (more favorable) in the Primary Service Area than in the
Within the Primary Service Area, lower in Victorville.
Chronic Drinkers
100%
80%
60%
40%
20%
7.2%
12.0%
4.0%
2.4%
4.2%
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
5.6%
6.1%
5.6%
Total
Area
California
United
States
0%
Apple Valley
(PSA)
SSA
Overall
Notes:
● Chronic drinkers are defined as having 60+ alcoholic drinks in the past month.
● *The state definition for chronic drinkers is males consuming 2+ drinks per day and females consuming 1+ drink per day.
159
 Chronic drinking is more prevalent among Total Area men and White
respondents.
Binge drinkers include:
1) MEN
who report
RELATED
ISSUE:
drinking
or more
See also 5
Stress
in the
alcoholic
drinks Health
on any &
Mental
singleMental
occasionDisorders
during
the
past month;
and
section
of this report.
2) WOMEN who report
drinking 4 or more
alcoholic drinks on any
single occasion during
the past month.
Chronic Drinkers
(Total Area, 2011)
100%
80%
60%
40%
20%
10.8%
7.3%
0.7%
4.4%
4.9%
4.8%
5.1%
7.1%
40 to 64
65+
<200%
FPL
200%+
FPL
White
4.7%
1.2%
5.6%
0%
Men
Women
18 to 39
Hispanic
Other
Total
Area
Notes:
● Chronic drinkers are defined as those having 60+ alcoholic drinks in the past month.
Binge Drinking
A total of 13.0% of Total Area adults are binge drinkers.
 Similar California findings.
 Satisfies the Healthy People 2020 target (24.3% or lower).
Significantly less favorable in the Secondary Service Area.
Within the Primary Service Area, no difference by community.
Binge Drinkers
100%
80%
60%
40%
21.4%
20%
12.0%
10.7%
11.0%
11.1%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
13.0%
15.8%
16.7%
California
United
States
0%
SSA
Overall
Total
Area
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective SA-14.3]
Notes:
● Binge drinkers are defined as men having 5+ alcoholic drinks on any one occasion or women consuming 4+ drinks on any one occasion. In 2006, this definition did not
distinguish by gender and represents the percentage of men and women consuming 5+ alcoholic drinks on one occasion.
160
Binge drinking is more prevalent among:
 Men (especially those under age 40).
 Adults under age 40.
 Whites and Hispanics.
Binge Drinkers
(Total Area, 2011)
100%
80%
60%
Men <40: 25.8%
40%
18.9%
20%
18.0%
11.0%
7.2%
10.5%
12.8%
13.9%
15.1%
4.4%
13.0%
4.3%
0%
Men
Sources: ●
●
●
●
●
Notes:
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective SA-14.3]
Binge drinkers are defined as men having 5+ alcoholic drinks on any one occasion or women consuming 4+ drinks on any one occasion.
Drinking & Driving
Note: As a self-reported
measure – and because this
indicator reflects potentially
illegal behavior – it is
reasonable to expect that it
might be underreported, and
that the actual incidence of
drinking and driving in the
community is likely higher.
A total of 1.9% of Total Area adults acknowledge having driven a vehicle in
the past month after they had perhaps too much to drink.
 Similar to the national findings.
Have Driven in the Past Month
After Perhaps Having Too Much to Drink
100%
80%
60%
40%
20%
1.0%
1.7%
1.7%
1.5%
3.8%
1.9%
3.5%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
0%
Notes:
161
A total of 4.5% of Total Area adults acknowledge either drinking and
driving or riding with a drunk driver in the past month.
Much higher in the Secondary Service Area.
Have Driven Drunk OR Ridden With a Driver
in the Past Month Who Had Too Much to Drink
100%
80%
60%
40%
20%
12.7%
2.5%
2.2%
2.7%
2.5%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
4.5%
5.5%
Total
Area
United
States
0%
SSA
Overall
Notes:
Age-Adjusted Drug-Induced Deaths
Between 2005 and 2007, there was an annual average age-adjusted druginduced mortality rate of 11.3 deaths per 100,000 population across San
Bernadino County.
 Comparable to the statewide rate.
 Comparable to the Healthy People 2020 target (11.3 or lower).
Drug-Induced Deaths: Age-Adjusted Mortality
25
20
15
11.3
11.1
California
12.2
10
5
0
United States
Notes:
162
 Drug-induced mortality rates appear to be lowest among Hispanics when
compared with Whites and “Other” races in San Bernadino County.
Drug-Induced Deaths: Age-Adjusted Mortality by Race
100
80
60
40
17.1
20
12.8
11.3
Non-Hispanic Other
6.4
0
Non-Hispanic White
Hispanic
Notes:
 The county's drug-induced mortality rate has increased since the 1999-2001
reporting period. Across California and the US, rates have also increased.
Drug-Induced Deaths: Age-Adjusted Mortality Trends
25
20
15
10
5
0
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
Healthy People 2020
11.3
11.3
11.3
11.3
11.3
11.3
11.3
8.3
8.0
8.3
10.3
11.5
12.0
11.3
California
6.9
7.1
8.3
10.2
10.5
10.7
11.1
United States
7.2
7.9
8.9
9.8
10.6
11.5
12.2
Notes:
163
Illicit Drug Use
For the purposes of this
survey, “illicit drug use”
includes use of illegal
substances or of
prescription drugs taken
without a physician's order.
A total of 3.2% of Total Area adults acknowledge using an illicit drug in the
past month.
 Similar to the proportion found nationally.
 Satisfies the Healthy People 2020 objective of 7.1% or lower.
Within the Primary Service Area, higher (less favorable) in Apple Valley.
Note: As a self-reported
measure – and because this
indicator reflects potentially
illegal behavior – it is
reasonable to expect that it
might be underreported,
and that actual illicit drug
use in the community is
likely higher.
Illicit Drug Use in the Past Month
100%
80%
60%
40%
20%
7.6%
1.4%
1.6%
3.1%
3.5%
3.2%
1.7%
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
0%
Apple Valley
(PSA)
Sources: ●
●
●
Notes:
●
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective SA-13.3]
Alcohol & Drug Treatment
A total of 7.6% of Total Area adults report that they have sought
professional help for an alcohol or drug problem at some point in their
lives.
 Twice the national findings.
Within the Primary Service Area, no statistical differences to report.
Have Ever Sought Professional Help
for an Alcohol- or Drug-Related Problem
100%
80%
60%
40%
20%
4.0%
7.8%
8.3%
7.0%
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
9.9%
7.6%
SSA
Overall
Total
Area
3.9%
0%
Apple Valley
(PSA)
United
States
Notes:
164
Tobacco Use
Tobacco use is the single most preventable cause of death and disease in the United States. Each year,
approximately 443,000 Americans die from tobacco-related illnesses. For every person who dies from
tobacco use, 20 more people suffer with at least one serious tobacco-related illness. In addition,
tobacco use costs the US $193 billion annually in direct medical expenses and lost productivity.
Scientific knowledge about the health effects of tobacco use has increased greatly since the first
Surgeon General's report on tobacco was released in 1964.
Tobacco use causes:
 Cancer
 Heart disease
 Lung diseases (including emphysema, bronchitis, and chronic airway obstruction)
 Premature birth, low birth weight, stillbirth, and infant death
There is no risk-free level of exposure to secondhand smoke. Secondhand smoke causes heart disease
and lung cancer in adults and a number of health problems in infants and children, including: severe
asthma attacks; respiratory infections; ear infections; and sudden infant death syndrome (SIDS).
Smokeless tobacco causes a number of serious oral health problems, including cancer of the mouth
and gums, periodontitis, and tooth loss. Cigar use causes cancer of the larynx, mouth, esophagus, and
lung.
–
Cigarette Smoking
Cigarette Smoking Prevalence
A total of 16.3% of Total Area adults currently smoke cigarettes, either
regularly (12.5% every day) or occasionally (3.8% on some days).
Cigarette Smoking Prevalence
(Total Area, 2011)
Regular Smoker
12.5%
Occasional Smoker
3.8%
Never Smoked 60.4%
Sources:
Notes:
Former Smoker
23.2%
 Fails to satisfy the Healthy People 2020 target (12% or lower).
Significantly higher in the Secondary Service Area.
165
Current Smokers
100%
Healthy People 2020 Target = 12% or Lower
Every Day
80%
Some Days
Current Smoker (% at Top)
60%
40%
25.2%
16.0%
20%
13.7%
13.6%
14.3%
3.3%
10.3%
3.7%
13.2%
4.9%
8.8%
10.6%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
2.8%
0%
4.2%
16.3%
12.8%
3.8%
21.0%
4.7%
8.1%
12.5%
SSA
Overall
Total
Area
16.6%
5.5%
11.1%
California
United
States
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective TU-1.1]
● Includes regular and occasional smokers (everyday and some days).
Sources:
Notes:
Cigarette smoking is more prevalent among:
 Men.
 Those with lower incomes.
 Residents of “Other” races.
Note also:
 7.0% of women of child-bearing age (ages 18 to 44) currently smoke. This is
notable given that tobacco use increases the risk of infertility, as well as the
risks for miscarriage, stillbirth and low birthweight for women who smoke
during pregnancy.
Current Smokers
(Total Area, 2011)
100%
Healthy People 2020 Target = 12% or Lower
80%
Among women 18-44, 7.0% are regular or occasional smokers.
60%
40%
21.5%
20%
25.9%
20.9%
11.3%
13.0%
Women
18 to 39
20.3%
13.4%
18.0%
12.4%
16.3%
10.9%
0%
Men
Sources: ●
●
Notes:
●
●
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective TU-1.1]
166
Environmental Tobacco Smoke
A total of 14.7% of Total Area adults (including smokers and non-smokers)
report that a member of their household has smoked cigarettes in the
home in the past month an average of four or more times per week.
Within the Primary Service Area, higher in Apple Valley, lower in Hesperia.
 Note that 6.2% of Total Area non-smokers are exposed to cigarette smoke at
home.
Member of Household Smokes at Home
100%
Note that 6.2% of non-smokers are exposed to smoke in the home.
80%
60%
40%
23.3%
13.4%
14.2%
Victorville
(PSA)
PSA
Overall
20%
7.9%
16.9%
14.7%
13.6%
SSA
Overall
Total
Area
United
States
0%
Apple Valley
(PSA)
Sources: ●
●
●
Notes:
●
●
Hesperia
(PSA)
Professional Research Consultants, Inc. PRC Community Health Survey. [Items 71, 193]
Healthy People 2010, 2nd Edition. US Department of Health and Human Services. Washington, DC: US Government Printing Office, November 2000. [Objective 27-5]
“Smokes at home” refers to someone smoking cigarettes, cigars, or a pipe in the home an average of four or more times per week in the past month.
 Notably higher among residents with lower incomes and those of “Other”
races.
Member of Household Smokes At Home
(Total Area, 2011)
100%
80%
60%
40%
20%
14.2%
15.1%
Men
Women
18.4%
10.8%
15.4%
25.5%
20.9%
10.1%
15.1%
14.7%
10.0%
0%
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
Notes:
● “Smokes at home” refers to someone smoking cigarettes, cigars, or a pipe in the home an average of four or more times per week in the past month.
167
Among households with children, 11.7% have someone who smokes
cigarettes in the home.
 Among households with children under age 7, 7.3% report that someone
smokes in the home.
Percentage of Households With Children
In Which Someone Smokes in the Home
100%
80%
60%
40%
HH w/Children
0-6 = 7.3%
20%
HH /Children
0-6 = 12.8%
11.7%
12.1%
Total Area Households w/Kids <18
US Households w/Kids <18
0%
Sources: ●
●
Notes:
●
●
Asked of all respondents with children under 18 at home.
“Smokes at home” refers to someone smoking cigarettes, cigars, or a pipe in the home an average of four or more times per week in the past month.
168
Smoking Cessation
Preventing tobacco use and helping tobacco users quit can improve the health and quality of life for
Americans of all ages. People who stop smoking greatly reduce their risk of disease and premature
death. Benefits are greater for people who stop at earlier ages, but quitting tobacco use is beneficial
at any age.
Many factors influence tobacco use, disease, and mortality. Risk factors include race/ethnicity, age,
education, and socioeconomic status. Significant disparities in tobacco use exist geographically; such
disparities typically result from differences among states in smoke-free protections, tobacco prices,
and program funding for tobacco prevention.
–
Health Advice About Smoking Cessation
A total of 59.5% of smokers say that a doctor, nurse or other health
professional has recommended in the past year that they quit smoking.
 Statistically similar to the national percentage.
Advised by a Healthcare
Professional in the Past Year to Quit Smoking
(Among Current Smokers, 2011)
100%
80%
60%
59.5%
63.7%
40%
20%
0%
Total Area
United States
Notes:
● Asked of all current smokers.
169
Smoking Cessation Attempts
More than one-half (54.4%) of regular smokers went without smoking for
one day or longer in the past year because they were trying to quit
smoking.
 Similar to the national percentage.
 Fails to satisfy the Healthy People 2020 target (80% or higher).
Have Stopped Smoking for 1 Day or Longer
in the Past Year in an Attempt to Quit Smoking
(Among Total Area Everyday Smokers, 2011)
100%
80%
60%
54.4%
56.2%
Total Area
United States
40%
20%
0%
Sources: ●
●
●
Notes:
●
Asked of respondents who smoke cigarettes every day.
170
Other Tobacco Use
Smokeless Tobacco
A total of 2.2% of Total Area adults use some type of smokeless tobacco
every day or on some days.
 Comparable to the national percentage.
Use of Smokeless Tobacco
100%
80%
60%
40%
20%
3.9%
1.6%
2.0%
2.3%
1.2%
2.2%
2.8%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
0%
Sources: ●
●
●
Notes:
●
●
Smokeless tobacco includes chewing tobacco or snuff.
Cigars
A total of 5.0% of Total Area adults use cigars every day or on some days.
 Similar to the national percentage.
Use of Cigars
100%
80%
60%
40%
20%
3.5%
4.8%
6.6%
5.2%
3.7%
5.0%
4.2%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
0%
Sources: ●
●
●
Notes:
●
171
ACCESS TO HEALTH
SERVICES
172
Health Insurance Coverage
Type of Healthcare Coverage
Survey respondents were
asked a series of
questions to determine
their healthcare insurance
coverage, if any, from
either private or
government-sponsored
sources.
A total of 55.3% of Total Area adults age 18 to 64 report having healthcare
coverage through private insurance. Another 25.2% report coverage
through a government-sponsored program (e.g., MediCal, Medicaid, Medicare,
military benefits).
Healthcare Insurance Coverage
(Among Adults Age 18 to 64; Total Area, 2011)
No Insurance/
Self-Pay 19.5%
Insured, EmployerBased 51.7%
Other Gov't Coverage
1.4%
Medi-Cal&Medicare
0.3%
VA/Military 4.4%
Medicare 5.0%
MediCal 14.1%
Sources:
Notes:
Insured, Self-Purchase
3.6%
● Reflects respondents aged 18 to 64.
Supplemental Coverage
Among Medicare recipients, the majority (59.6%) has additional,
supplemental healthcare coverage.
 Lower than that reported among Medicare recipients nationwide.
Have Additional Supplemental Coverage
(Among Recipients of Medicare, 2011)
100%
75.5%
80%
60%
59.6%
40%
20%
0%
Total Area Medicare Recipients
United States Medicare Recipients
Notes:
● Asked of all respondents with Medicare coverage.
173
Prescription Drug Coverage
Among insured adults, 95.1% report having prescription coverage as part
of their insurance plan.
Within the Primary Service Area, statistically similar by community.
Insurance Covers At Least Partial Prescriptions
(Among Insured Respondents, 2011)
100%
97.8%
93.8%
95.0%
95.4%
93.9%
95.1%
93.9%
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
80%
60%
40%
20%
0%
Apple Valley
(PSA)
Notes:
● Asked of all respondents with healthcare insurance coverage.
Recent Lack of Coverage (Insurance Instability)
Among currently insured adults in the Total Area, 10.3% report that they
were without healthcare coverage at some point in the past year.
 More than twice the US prevalence.
Within the Primary Service Area, lower (more favorable) in Apple Valley.
Went Without Coverage at Some Point in the Past Year
(Insured Adults, 2011)
100%
80%
60%
40%
14.6%
20%
4.2%
9.1%
9.7%
Victorville
(PSA)
PSA
Overall
13.3%
10.3%
4.8%
0%
Apple Valley
(PSA)
Hesperia
(PSA)
SSA
Overall
Total
Area
United
States
Notes:
174
Among insured adults, the following segments are more likely to have gone without
healthcare insurance coverage at some point in the past year:
Went Without Coverage at Some Point in the Past Year
(Insured Adults, 2011)
100%
80%
60%
40%
20%
9.0%
14.0%
11.6%
18.4%
9.9%
4.8%
6.5%
6.7%
200%+
FPL
White
13.7%
12.8%
Hispanic
Other
10.3%
0%
Men
Women
18 to 39
40 to 64
65+
<200%
FPL
Total
Area
Notes:
● Asked of insured respondents.
Lack of Health Insurance Coverage
Here, lack of health
insurance coverage reflects
respondents age 18 to 64
(thus, excluding the
Medicare population)
who have no type of
insurance coverage for
healthcare services –
neither private insurance
nor government-sponsored
plans (e.g., Medicaid).
Among adults age 18 to 64, one-fifth (19.5%) reports having no insurance
coverage for healthcare expenses.
 Nearly identical to the state figure.
 Similar to the national finding.
 The Healthy People 2020 target is universal coverage (0% uninsured).
Lack of Healthcare Insurance Coverage
(Among Total Area Adults Under 65, 2011)
100%
Healthy People 2020 Target = 0.0% (Universal Coverage)
80%
60%
40%
19.9%
18.0%
18.1%
18.5%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
20%
23.9%
19.5%
19.6%
Total
Area
California
14.9%
0%
SSA
Overall
United
States
● US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective AHS-1]
Notes:
● Asked of all respondents under the age of 65.
175
The following population segments are more likely to be without healthcare
insurance coverage:
 Young adults (18-39).
 Residents living at lower incomes (note the 34.1% uninsured prevalence
among adults living below the 200% poverty threshold).
 Hispanics and residents of “Other” races.
Lack of Healthcare Insurance Coverage
(Total Area Adults Under 65, 2011)
100%
Healthy People 2020 Target = 0.0% (Universal Coverage)
80%
60%
34.1%
40%
17.3%
20%
21.6%
24.7%
13.6%
25.0%
23.4%
Hispanic
Other
19.5%
12.4%
8.3%
0%
Men
Sources: ●
●
●
●
Notes:
Women
18 to 39
40 to 64
<200%
FPL
200%+
FPL
White
Total
Area
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective AHS-1]
Asked of all respondents under the age of 65.
 As might be expected, uninsured adults in the Total Area are less likely to
receive routine care and preventive health screenings, and are more likely to
have experienced difficulties accessing healthcare.
 Further, those without healthcare coverage are twice as likely as the insured
population to have used the ER for medical care more than once in the past
year.
Preventive Healthcare
(By Insured Status; Total Area, 2011)
Uninsured
97.1%
100%
84.9%
Insured
91.6%
82.0%
78.2%
80%
71.1%
67.3%
60.4%
60%
45.7%
49.1%
48.2%
40%
30.3%
47.0%
30.5%
21.6%
20%
10.6%
15.0%
4.1%
0%
BP Test/
Past 2 Yrs
Sources:
Notes:
Cholesterol
Test/Past
5 Yrs
Specific
Source/Ongoing Care
Checkup/
Past Yr
Dental Visit/
Past Yr
Eye Exam/
Past 2 Yrs
Access
Difficulties/
Past Yr
Used ER
>Once/
Past Yr
Difficulty
Getting
Care/Child
● Professional Research Consultants, Inc. PRC Community Health Survey. [Items 17, 20, 21, 23, 56, 59, 132, 200, 203]
176
Difficulties Accessing Healthcare
Access to comprehensive, quality health care services is important for the achievement of health
equity and for increasing the quality of a healthy life for everyone. It impacts: overall physical, social,
and mental health status; prevention of disease and disability; detection and treatment of health
conditions; quality of life; preventable death; and life expectancy.
Access to health services means the timely use of personal health services to achieve the best health
outcomes. It requires three distinct steps: 1) Gaining entry into the health care system; 2) Accessing a
health care location where needed services are provided; and 3) Finding a health care provider with
whom the patient can communicate and trust.
–
Difficulties Accessing Services
This indicator reflects the
percentage of the total
population experiencing
problems accessing
healthcare in the past year,
regardless of whether they
needed or sought care.
One-half (50.4%) of Total Area adults reports some type of difficulty or
delay in obtaining healthcare services in the past year.
Within the Primary Service Area, higher in Apple Valley, lower (more
favorable) in Victorville.
Experienced Difficulties or Delays of Some Kind
in Receiving Needed Healthcare in the Past Year
100%
80%
62.2%
60%
56.5%
51.7%
48.9%
50.4%
38.4%
40%
37.3%
20%
0%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
Notes:
Note that the following demographic groups more often report difficulties accessing
healthcare services:
 Young adults.
 Residents of “Other” races.
177
Experienced Difficulties or Delays of Some Kind
in Receiving Needed Healthcare in the Past Year
(Total Area, 2011)
100%
80%
48.8%
51.8%
66.5%
63.0%
59.3%
60%
48.9%
44.5%
47.8%
50.4%
45.0%
40%
28.4%
20%
0%
Men
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
Notes:
Barriers to Healthcare Access
To better understand
healthcare access barriers,
survey participants were asked
whether any of six types of
barriers to access prevented
them from seeing a physician
or obtaining a needed
prescription in the
past year.
Again, these percentages
reflect the total population,
regardless of whether medical
care was needed or sought.
Of the tested barriers, obtaining a medical appointment impacted the
greatest share of Total Area adults (24.6% say that they experienced
difficulty getting an appointment in the past year).
 The proportion of Total Area adults impacted was statistically less favorable
than that found nationwide for each of the tested barriers.
Barriers to Access Have
Prevented Medical Care in the Past Year
100%
Total Area
United States
80%
60%
40%
24.6%
20%
16.5%
21.5%
15.0%
18.6%
14.0%
17.2%
14.3%
15.8%
10.7%
13.2%
7.7%
0%
Getting a
Dr Appointment
Sources:
Notes:
Cost
(Prescriptions)
Cost
(Doctor Visit)
Inconvenient
Office Hours
Finding
a Doctor
Lack of
Transportation
178
Prescriptions
Among all Total Area adults, 19.1% skipped or reduced medication doses in
the past year in order to stretch a prescription and save money.
 Statistically similar to national findings.
Skipped or Reduced Prescription Doses in
Order to Stretch Prescriptions and Save Money
100%
80%
60%
40%
25.9%
18.5%
18.8%
Apple Valley
(PSA)
Hesperia
(PSA)
20%
16.1%
17.6%
Victorville
(PSA)
PSA
Overall
19.1%
14.8%
0%
SSA
Overall
Total
Area
United
States
Sources: ● Professional Research Consultants, Inc. PRC Community Health Survey [Item 13]
Notes:
Adults more likely to have skipped or reduced their prescription doses include:
 Respondents with lower incomes.
 Uninsured adults.
Skipped or Reduced Prescription Doses in
Order to Stretch Prescriptions and Save Money
(Total Area, 2010)
100%
80%
60%
36.9%
40%
29.7%
20%
18.0%
20.2%
Men
Women
18.3%
22.6%
21.0%
15.7%
13.7%
15.0%
200%+
FPL
White
24.7%
19.1%
15.8%
0%
18 to 39
40 to 64
65+
<200%
FPL
Hispanic
Other
Insured
Uninsured
Total
Area
Sources: ● 2010 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 13]
Notes:
179
Accessing Healthcare for Children
Surveyed parents were also
asked if, within the past
year, they experienced any
trouble receiving medical
care for a randomlyselected child in their
household.
A total of 6.5% of parents say there was a time in the past year when they
needed medical care for their child, but were unable to get it.
 Much higher than what is reported nationwide.
Had Trouble Obtaining Medical Care for Child in the Past Year
(Total Area Parents of Children <18, 2011)
100%
80%
Parents with trouble obtaining
medical care for their child reported
barriers due to cost or lack of insurance coverage.
Inconvenient office hours also hindered local parents.
60%
40%
20%
6.5%
1.9%
0%
Total Area
United States
Notes:
Among the parents experiencing difficulties, the majority cited cost or a lack of
insurance as the primary reason; others cited inconvenient office hours.
180
Primary Care Services
Improving health care services depends in part on ensuring that people have a usual and ongoing
source of care. People with a usual source of care have better health outcomes and fewer disparities
and costs. Having a primary care provider (PCP) as the usual source of care is especially important. PCPs
can develop meaningful and sustained relationships with patients and provide integrated services
while practicing in the context of family and community. Having a usual PCP is associated with:
 Greater patient trust in the provider
 Good patient-provider communication
 Increased likelihood that patients will receive appropriate care
Having a specific source
of ongoing care includes
having a doctor's office,
clinic, urgent care
center, walk-in clinic,
health center facility,
hospital outpatient
clinic, HMO or prepaid
group, military/VA clinic,
or some other kind of
place to go if one is sick
or needs advice about
his or her health. A
hospital emergency
room is not considered a
source of ongoing care
in this instance.
Improving health care services includes increasing access to and use of evidence-based preventive
services. Clinical preventive services are services that: prevent illness by detecting early warning signs
or symptoms before they develop into a disease (primary prevention); or detect a disease at an
earlier, and often more treatable, stage (secondary prevention).
–
Specific Source of Ongoing Care
A total of 72.7% of Total Area adults were determined to have a specific
source of ongoing medical care.
 Among adults age 18-64, 70.1% have a specific source for ongoing medical
care, similar to national findings.
-
Fails to satisfy the Healthy People 2020 target for this age group
(89.4%or higher).
 Among adults 65+, 82.3% have a specific source for care, nearly identical to
that reported among seniors nationally.
-
Fails to satisfy the Healthy People 2020 target of 100% for seniors.
Have a Specific Source of Ongoing Medical Care
Healthy People 2020 Targets = 89.4% or Higher (18-64), 100% (65+)
Total Area
United States
100%
82.6%
82.3%
80%
75.1%
70.1%
60%
40%
20%
0%
Aged 18-64
Sources: ●
●
●
Notes:
●
Aged 65+
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objectives AHS-5.3, 5.4]
181
When viewed by demographic characteristics, the following population segments
are less likely to have a specific source of care:
 Lower-income adults.
Have a Specific Source of Ongoing Medical Care
(Total Area, 2011)
100%
Healthy People 2020 Target = Age 18-64: 89.4%/Higher; Age 65+: 100%
82.3%
75.6%
80%
77.6%
74.6%
69.7%
75.6%
68.6%
66.3%
73.9%
72.7%
Other
Total
Area
62.1%
60%
40%
20%
0%
Men
Sources: ●
●
●
●
Notes:
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objectives AHS-5.3, 5.4]
Type of Place Used for Medical Care
When asked where they usually go if they are sick or need advice about
their health, the greatest share of respondents (36.9%) identified a
particular doctors office.
Another 32.4% say they usually go to some type of clinic, while 4.3% rely
on a hospital emergency room.
Particular Place Utilized for Medical Care
(Total Area, 2011)
Other 9.8%
Hospital ER 4.3%
Dr's Office 36.9%
None 16.6%
Clinic 32.4%
Sources:
Notes:
182
Utilization of Primary Care Services
Adults
Two-thirds (67.6%) of adults visited a physician for a routine checkup in the
past year.
 Nearly identical to national findings.
Significantly less favorable in the Secondary Service Area.
Within the Primary Service Area, higher in Apple Valley.
Have Visited a Physician for a Checkup in the Past Year
100%
80%
76.0%
70.9%
70.5%
67.5%
60%
67.6%
67.3%
Total
Area
United
States
52.1%
40%
20%
0%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Notes:
 Men are less likely than women to have a recent checkup.
 Adults under age 40 are less likely to have received routine care in the past
year (note the positive correlation with age).
 Residents in the lower income breakout are less likely than those on higher
incomes to report a recent checkup.
Have Visited a Physician for a Checkup in the Past Year
(Total Area, 2011)
100%
88.5%
80%
73.0%
72.2%
71.3%
62.8%
55.6%
60%
69.0%
66.2%
68.4%
67.6%
Hispanic
Other
Total
Area
60.4%
40%
20%
0%
Men
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Notes:
183
Children
Among surveyed parents, 88.3% report that their child has had a routine
checkup in the past year.
 No statistical difference by child's age.
Child Has Visited a Physician
for a Routine Checkup in the Past Year
(Total Area Parents of Children <18, 2011)
100%
91.2%
80%
89.3%
83.4%
88.3%
87.0%
Total
Area
United
States
60%
40%
20%
0%
Total Area
5/Under
Total Area
Age 6 to 12
Total Area
Teens
Notes:
184
A total of 12.3% of Total Area adults have gone to a hospital emergency
room more than once in the past year about their own health.
 Nearly twice the national findings.
Have Used a Hospital Emergency Room
More Than Once in the Past Year
100%
80%
Reason for recent ER use:
Life-Threatening: 67.6%
After-Hours: 13.4%
Barriers to Healthcare: 13.0%
60%
40%
20%
16.5%
8.5%
10.8%
11.6%
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
15.2%
12.3%
6.5%
0%
Apple Valley
(PSA)
SSA
Overall
Total
Area
United
States
Notes:
Of those using a hospital ER, 67.6% say this was due to an emergency or lifethreatening situation, while 13.4% indicated that the visit was during afterhours or on the weekend. Another 13.0% cited difficulties accessing primary
care for various reasons.
 Adults more likely to have used an ER for medical care more than once in
the past year include young adults, those living on lower incomes, Hispanics,
and residents of “Other” races.
Have Used a Hospital Emergency Room
More Than Once in the Past Year
(Total Area, 2011)
100%
80%
60%
40%
20%
11.6%
12.9%
23.3%
18.3%
16.6%
8.4%
10.5%
40 to 64
65+
15.1%
4.0%
12.3%
6.9%
0%
Men
Women
18 to 39
<200%
FPL
200%+
FPL
White
Hispanic
Other
Total
Area
Notes:
185
Oral Health
The health of the mouth and surrounding craniofacial (skull and face) structures is central to a
person's overall health and well-being. Oral and craniofacial diseases and conditions include: dental
caries (tooth decay); periodontal (gum) diseases; cleft lip and palate; oral and facial pain; and oral and
pharyngeal (mouth and throat) cancers.
The significant improvement in the oral health of Americans over the past 50 years is a public health
success story. Most of the gains are a result of effective prevention and treatment efforts. One major
success is community water fluoridation, which now benefits about 7 out of 10 Americans who get
water through public water systems. However, some Americans do not have access to preventive
programs. People who have the least access to preventive services and dental treatment have greater
rates of oral diseases. A person's ability to access oral healthcare is associated with factors such as
education level, income, race, and ethnicity.
Oral health is essential to overall health. Good oral health improves a person's ability to speak, smile,
smell, taste, touch, chew, swallow, and make facial expressions to show feelings and emotions.
However, oral diseases, from cavities to oral cancer, cause pain and disability for many Americans.
Good self-care, such as brushing with fluoride toothpaste, daily flossing, and professional treatment, is
key to good oral health. Health behaviors that can lead to poor oral health include:
 Tobacco use
 Excessive alcohol use
 Poor dietary choices
Barriers that can limit a person's use of preventive interventions and treatments include:
 Limited access to and availability of dental services
 Lack of awareness of the need for care
 Cost
 Fear of dental procedures
There are also social determinants that affect oral health. In general, people with lower levels of
education and income, and people from specific racial/ethnic groups, have higher rates of disease.
People with disabilities and other health conditions, like diabetes, are more likely to have poor oral
health.
Community water fluoridation and school-based dental sealant programs are 2 leading evidencebased interventions to prevent tooth decay.
Major improvements have occurred in the nation's oral health, but some challenges remain and new
concerns have emerged. One important emerging oral health issue is the increase of tooth decay in
preschool children. A recent CDC publication reported that, over the past decade, dental caries (tooth
decay) in children ages 2 to 5 have increased.
Lack of access to dental care for all ages remains a public health challenge. This issue was highlighted
in a 2008 Government Accountability Office (GAO) report that described difficulties in accessing
dental care for low-income children. In addition, the Institute of Medicine (IOM) has convened an
expert panel to evaluate factors that influence access to dental care.
Potential strategies to address these issues include:
 Implementing and evaluating activities that have an impact on health behavior.
 Promoting interventions to reduce tooth decay, such as dental sealants and fluoride use.
 Evaluating and improving methods of monitoring oral diseases and conditions.
 Increasing the capacity of State dental health programs to provide preventive oral health
services.
 Increasing the number of community health centers with an oral health component.
–
186
Dental Care
Adults
Just over 1 in 2 Total Area adults (54.9%) have visited a dentist or dental
clinic (for any reason) in the past year.
 Less favorable than statewide findings.
 Less favorable than national findings.
 Satisfies the Healthy People 2020 target (49% or higher).
Have Visited a Dentist or
Dental Clinic Within the Past Year
100%
80%
70.3%
54.2%
55.7%
56.4%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
60%
55.6%
PSA
Overall
51.8%
66.9%
54.9%
40%
20%
0%
Sources:
Notes:
SSA
Overall
Total
Area
California
United
States
●
●
●
●
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective OH-7]
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and Human Services,
Note the following:
 Persons living in the higher income categories report much higher utilization
of oral health services (persons below 200% of poverty fail to satisfy the
Healthy People 2020 objective).
 As might be expected, persons without dental insurance report much lower
utilization of oral health services than those with dental coverage.
187
Have Visited a Dentist or
(Total Area, 2011)
100%
80%
60%
71.1%
64.2%
58.8%
51.0%
54.9%
54.6%
57.6%
52.8%
54.9%
54.4%
44.3%
37.5%
40%
29.3%
20%
0%
Men
Sources:
Notes:
●
●
●
●
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Other
Dental
Insur.
No
Dental
Total
Area
Children
A total of 77.9% of parents report that their child (age 2 to 17) has been to
a dentist or dental clinic within the past year.
 Satisfies the Healthy People 2020 target (49% or higher).
 As may be expected, regular dental care is notably lower among children
under 6.
Child Has Visited a Dentist or
(Asked of Adults With Children Aged 2-17; Total Area, 2011)
100%
92.3%
80%
89.5%
77.9%
79.2%
Total Area
United States
60%
40%
36.1%
20%
0%
Total Area
Age 2-5
Sources:
Notes:
●
●
●
●
Total Area
Age 6-12
Total Area
Teens
Asked of all respondents with children aged 2 through 17.
188
Dental Insurance
Over 6 in 10 Total Area adults (62.6%) have dental insurance that covers all
or part of their dental care costs.
 Similar to the national finding.
Within the Primary Service Area, higher (more favorable) in Victorville.
Have Insurance Coverage That Pays
All or Part of Dental Care Costs
100%
80%
60%
71.2%
56.5%
57.8%
Apple Valley
(PSA)
Hesperia
(PSA)
63.0%
60.6%
62.6%
60.8%
PSA
Overall
SSA
Overall
Total
Area
United
States
40%
20%
0%
Victorville
(PSA)
Notes:
189
Vision Care
A total of 46.2% of residents had an eye exam in the past two years during
which their pupils were dilated.
 Statistically lower than national findings.
RELATED ISSUE:
See also Vision & Hearing
in the Deaths & Disease
Had an Eye Exam in the Past Two
Years During Which the Pupils Were Dilated
100%
80%
57.5%
60%
40%
50.0%
48.6%
46.6%
44.1%
46.2%
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
39.2%
20%
0%
Apple Valley
(PSA)
United
States
Notes:
 Lower in women than in men.
 Note the positive correlation between age and recent eye exams.
Had an Eye Exam in the Past Two
Years During Which the Pupils Were Dilated
(Total Area, 2011)
100%
78.5%
80%
60.0%
60%
51.0%
50.9%
41.4%
50.6%
40.1%
47.0%
46.2%
Other
Total
Area
40.1%
40%
21.6%
20%
0%
Men
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
White
Hispanic
Notes:
190
HEALTH EDUCATION &
OUTREACH
191
Healthcare Information Sources
Family physicians and the Internet are residents primary sources of
healthcare information.
 46.3% of Total Area adults cited their family physician as their primary
source of healthcare information (similar to national findings).
 The Internet received the second-highest response, with 24.9% (higher than
found nationally.
-
Other sources mentioned include books and magazines (mentioned by
4.7%), friends and relatives (4.1%), hospital publications (4.1%), and
insurance (3.2%).
 Just 2.6% of survey respondents say that they do not receive any healthcare
information.
Primary Source of Healthcare Information
(Total Area, 2011)
Hosp. Pub. Insurance
3.2%
4.1%
Friends/
Relatives
4.1%
Books/
Magazines
4.7%
Other
10.1%
None
2.6%
Books/ Newsp. None
Magazines 5.0% 1.5%
4.2%
Family Dr
46.3%
Internet
24.9%
Insurance
3.3%
Friends/
Relatives
7.0%
Family Dr
43.4%
Other
17.1%
Internet
18.5%
Total Area
United States
Notes:
192
Participation in Health Promotion Events
Educational and community-based programs play a key role in preventing disease and injury,
improving health, and enhancing quality of life.
Health status and related-health behaviors are determined by influences at multiple levels: personal,
organizational/institutional, environmental, and policy. Because significant and dynamic
interrelationships exist among these different levels of health determinants, educational and
community-based programs are most likely to succeed in improving health and wellness when they
address influences at all levels and in a variety of environments/settings.
Education and community-based programs and strategies are designed to reach people outside of
traditional healthcare settings. These settings may include schools, worksites, healthcare facilities,
and/or communities.
Using nontraditional settings can help encourage informal information sharing within communities
through peer social interaction. Reaching out to people in different settings also allows for greater
tailoring of health information and education.
Educational and community-based programs encourage and enhance health and wellness by
educating communities on topics such as: chronic diseases; injury and violence prevention; mental
illness/behavioral health; unintended pregnancy; oral health; tobacco use; substance abuse; nutrition;
and obesity prevention.
–
A total of 11.9% of Total Area adults participated in some type of
organized health promotion activity in the past year, such as health fairs,
health screenings, or seminars.
 Lower than the national prevalence.
Significantly higher in the Primary Service Area than in the Secondary Service
Area.
Participated in a Health
Promotion Activity in the Past Year
100%
Note that 44.0% of adults who participated in a health promotion activity in the past year indicate that
it was sponsored by an employer (vs. 58.0% across the US).
80%
60%
40%
22.2%
20%
14.0%
11.1%
15.8%
13.7%
11.9%
4.0%
0%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
Notes:
193
The following chart outlines participation by various demographic characteristics.
 No statistical difference by demographics.
Participated in a Health
Promotion Activity in the Past Year
(Total Area, 2011)
100%
80%
60%
40%
20%
Healthy People 2010 Target =
90% or Higher for Adults 65+
12.7%
11.2%
10.3%
11.2%
Men
Women
18 to 39
40 to 64
15.3%
9.0%
13.1%
11.7%
200%+
FPL
White
9.0%
14.0%
12.3%
Other
Insured
10.0%
11.9%
Uninsured
Total
Area
0%
Sources: ●

●
●
Notes:
65+
<200%
FPL
Hispanic
Healthy People 2010. 2nd Edition. US Department of Health & Human Services. Washington, DC: US Government Printing Office, November 2000. [Objective 7-12]
194
PERCEPTIONS OF
HEALTHCARE
195
Ratings of Local Healthcare Services
A total of 4 in 10 Total Area adults (39.6%) rate the overall healthcare
services available in their community as “excellent” or “very good.”
 Less favorable than found nationally.
 Another 34.3% gave “good” ratings.
Rating of Overall Healthcare
Services Available in the Community
(Total Area, 2011)
Poor 11.8%
Excellent 16.0%
Fair 14.2%
Very Good 23.6%
Good 34.3%
Notes:
However, 26.0% of residents characterize local healthcare services as “fair”
or “poor.”
 Less favorable than reported nationally.
Perceive Local Healthcare Services as “Fair” or “Poor”
100%
80%
60%
40%
27.4%
27.1%
24.1%
25.9%
26.5%
26.0%
15.3%
20%
0%
Apple Valley
(PSA)
Hesperia
(PSA)
Victorville
(PSA)
PSA
Overall
SSA
Overall
Total
Area
United
States
Notes:
196
The following residents are more critical of local healthcare services:
 Young adults.
 Residents with lower incomes.
Perceive Local Healthcare Services as “Fair” or “Poor”
(Total Area, 2011)
100%
80%
60%
40%
36.1%
33.0%
25.0%
27.1%
24.2%
31.4%
26.2%
24.3%
White
Hispanic
20.0%
26.0%
20%
10.3%
0%
Men
Women
18 to 39
40 to 64
65+
<200%
FPL
200%+
FPL
Other
Total
Area
Notes:
197

Community Health Needs Assessment

Transcription

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